清远地区产ESBLs肺炎克雷伯菌药敏分析与基因研究

Drug Sensitivity Analysis and Gene Distribution of Producing ESBLs Klebsiella Pneumoniae in Qingyuan Area

目的:了解清远地区产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药性及基因型分布。方法:按照美国临床实验室标准化委员会(NCCLS)推荐的表型确证试验确定临床标本中产ESBLs肺炎克雷伯菌224株,用Etest测定其最低抑菌浓度(MIC),分别用TEM、SHV、CTX-M通用引物进行聚合酶链反应(PCR),并对结果进行分析。结果:清远地区产ESBLs肺炎克雷伯菌对多种抗生素耐药,对美罗培南的敏感率最高(88. 9%),其次是亚胺培南(83. 9%),哌拉西林/他唑巴坦和阿米卡星的敏感率分别为72. 8%和70. 2%。PCR扩增结果显示TEM、SHV和CTX-M基因的阳性率分别为45%、51. 7%和76. 3%,15. 1%的菌株同时携带多个基因。结论:清远地区产ESBLs肺炎克雷伯菌对美罗培南的敏感率最高;最常见的基因型是CTX-M,其次为SHV、TEM。

Objective To investigate the profile of genotype and antibiotic resistance of strains producing extended spcctrum beta-lactamases（ESBLs） klebsiella pneumoniae in qingyuan area. Methods ： A total of 224 producing ESBLs klebsiella pneumoniae isolates were determined by NCCLS methods. It′s MIC was determined by the Etest method.The presence of TEM、SHV、CTX-M genes was determined by specific PCR assays. Results ： Producing ESBLs klebsiella pneumoniae in qingyuan area were resistant to many antibiotics.MIC test showed these strains were 88.9% susceptible to meropenem, 83.9% to imipenem, 72.8% to piperacillin/tazobactam, 70.2% to amikacin. PCR assay showed that the postive rate of TEM gene, was 45%, SHV was 51.7%, CTX-M was 76.3%, 15.1% strains carried more than one type of ESBLs gene. Conclusion ： Producing ESBLs klebsiella pneumoniae is most susceptible to meropenem. The most commom ESBLs in klebsiella pneumoniaes was CTX-M in qingyuan area, followed by SHV, TEM.