儿童呼吸道感染产超广谱β-内酰胺酶菌的耐药表型及耐药基因研究

Research on drug resistant phenotypes and genes of extended-spectrumβ-lactamase producing strains in children with respiratory tract infections

目的分析儿童呼吸道感染产超广谱β-内酰胺酶(ESBLs)菌的耐药表型及耐药基因,提高对儿童呼吸道感染产ESBLs菌的认识及预防治疗效果。方法选择2012年3月-2013年4月诊治的142例呼吸道感染患儿临床分离的产ESBLs细菌,药敏试验采用纸片扩散法(K-B)检测,运用PCR技术对耐药基因进行分析。结果 142例呼吸道感染患儿临床分离的71株产ESBLs细菌中产ESBLs肺炎克雷伯菌32株、大肠埃希菌39株,检出率分别为47.06%、52.70%;分离的产ESBLs细菌对头孢唑林、头孢呋辛、头孢克洛、亚胺培南、美罗培南耐药率均达100.0%;71株产ESBLs细菌检出耐药基因SHV型9株、TEM型17株、CTX-M型13株、SHV+CTX-M型8株,分别占12.68%、23.94%、18.31%、11.27%。结论产ESBLs细菌对碳青酶烯类抗菌药物耐药率较高,且具有多药耐药表型特征,大部分菌株同时携带≥2种ESBLs基因型。

OBJECTIVE To analyze the drug resistant phenotype and gene of extended-spectrumβ-lactamase（ESBLs）producing bacteria in children with respiratory tract infections,so as to improve the understanding and prevention effects on ESBLs producing bacteria in respiratory tract infections.METHODS Clinical isolates of ESBLs producing bacteria from 142 children with respiratory tract infections from Mar.2012 to Apr.2013 were selected for drug susceptibility test with K-B disk diffusion assay method and for analysis of the resistance gene with PCR technology.RESULTS The 71 ESBLs producing bacteria from the 142 children with respiratory tract infections included 32 ESBLs producing Klebsiella pneumonia（47.06%）and 39 Escherichia coli（52.70%）.The isolated ESBLs producing bacteria had 100%resistance to cefazolin,cefuroxime,cefaclor,Imipenem,and meropenem.The 71 ESBLs producing bacteria included 9 SHV-type resistant genes accounting for 12.68%,17 TEMtype resistant genes accounting for 23.94%,13 CTX-Mtype resistant genes accounting for 18.31%and 8 SHV＋CTX-Mtype resistant genes accounting for 11.27%.CONCLUSION ESBLs producing bacteria has a resistance rate to carbapenem antibiotic drugs and has multi-drug resistant phenotypes,most strains carry two or more kinds of ESBLs genotype.