产超广谱β-内酰胺酶肺炎克雷伯菌的临床分布及耐药特征

Clinical distribution and drug resistance characteristics of ESBLs-producing Klebsiella pneumonia

目的了解产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的临床分布、基因型及其耐药情况,为临床合理使用抗菌药物提供参考。方法采用ATB细菌鉴定仪对临床送检标本进行肺炎克雷伯菌鉴定和药敏试验,双纸片法确证试验检测ESBLs表型,通过聚合酶链反应(PCR)对ESBLs阳性菌株进行基因型检测。结果481株肺炎克雷伯菌中产ESBLs菌116株(24.12%),科室分布主要来源于呼吸科(23.28%),标本主要来源于痰液(91株)。PCR结果显示,116株产ESBLs肺炎克雷伯菌中,CTX型61株(52.59%),TEM型17株(14.66%),SHV型16株(13.79%),22株携带两种基因型(18.96%)。药敏结果显示,116株产ESBLs肺炎克雷伯菌对阿莫西林、替卡西林、头孢噻吩和头孢呋辛的耐药率为100.00%,对哌拉西林、头孢他啶和头孢吡肟的耐药率在76.00%以上,对美洛培南和亚胺培南全部敏感。结论临床分离的产ESBLs肺炎克雷伯菌主要来源于呼吸科,基因型主要为CTX型。产ESBLs肺炎克雷伯菌对多种抗菌药物呈现多重耐药性。

Objective To understand the clinical distribution, genotypes and drug resistance of extend spectrum β-lactamases （ESBLs）-producing Klebsiella pneumonia to provide reference for clinical rational use of antimicrobial agents. Methods The identification and drug susceptibility test of Klebsiella pneumonia in clinically submitted specimens were performed by using ATB bacteria identification instrument. The ESBLs phenotypes were detected by double paper confirmatory test and the ESBLs genotypes of ESBLs positive strains were tested by polymerase chain reaction（PCR）. Results Among 481 strains of Klebsiella pneumonia, 116 strains（24.12%） produced ESBLs,which mainly derived from the respiratory department（23.28%）, the specimens mainly came from sputum（91 strains）. The PCR results showed that among 116 strains of ESBLs-producing Klebsiella pneumonia, 61 strains （52.59%） wereCTX genotype, 17 strains（14. 66%） were TEM genotype, 16 strains （13. 79%） were SHV genotype, 22 strain （18.96 %） were two genotypes. The drug susceptibility results showed that 116 strains of ESBLs-produeing K lebsiella pneumonia had the resistance rate of 100.00 % to amoxicillin,ticarcillin, cefalotin and cefuroxime, and resistance rate of more than 76.00 % to piperaciliin,ceftazidime and cefepime. All were sensitive to meropenem and imipenem. Conclusion Clinically isolated ESBLs-producing Klebsiella pneumoniae is mainly derived from respiratory department,the main genotype is CTX. ESBLs-producing Klebsiella pneumonia shows multiple drug resistance to multiple kinds of antimicrobial agents.