唐山工人医院重症监护病房耐碳青霉烯肺炎克雷白菌耐药表型分析

Drug-resistant phenotype analysis of carbapenem resistant Klebsiella pneumoniae in ICU of Tangshan Worker's Hospital

目的:检测耐碳青霉烯肺炎克雷白菌KPC酶及金属酶,为临床合理用药提供实验室依据。方法:选择耐碳青霉烯肺炎克雷白菌35株,采用改良Hodge试验检测KPC酶,采用纸片协同法检测金属酶。结果:35株肺炎克雷白菌改良Hodge试验均呈阳性;其不但对碳青霉烯类抗生素耐药,且对大部分β内酰胺类抗生素耐药(耐药率100%),对喹诺酮类抗生素耐药(耐药率>70%);对少数抗生素,如头孢哌酮/舒巴坦、阿米卡星、米诺环素、复方新诺明耐药率较低。2株同时产KPC及MBL的肺炎克雷白菌对碳青霉烯类抗生素耐药,其对所检测抗生素耐药率均100%。结论:耐碳青霉烯肺炎克雷白菌既能将耐药基因传递给其他细菌,同时又能够接受其他细菌的耐药基因,使该菌更易产生耐药性。

Objective:KPC enzyme and metal enzyme of carbapenem resistant Klebsiella pneumoniae were detected to provide laboratory basis for clinical rational use of drugs.Methods:35strains of carbapenem resistant Klebsiella pneumoniae were selected.We used the modified Hodge test to detect the KPC enzyme,and disk synergy method to detect the metal enzyme.Results:The modified Hodge tests of35strains of carbapenem resistant Klebsiella pneumoniae were all positive.It was not only resistant to carbapenems,but also had a resistance rate of100%to most beta lactam antibiotics.The resistance rate for quinolones was also more than70%.The rates of resistance to a small number of antibiotics were low,such as cefoperazone/sulbactam,amikacin,minocycline and compound sulfamethoxazole.2strains of Klebsiella pneumoniae with KPC and MBL were not only resistant to carbapenems,but their resistance rates to all tested antibiotics were100%.Conclusion:Carbapenem resistant Klebsiella pneumoniae can transfer resistance genes to other bacteria,and also accept resistance genes of other bacteria,which maked the bacteria more susceptible to drug resistance.