Occurrence of K1 and K2 serotypes and genotypic characteristics of extended spectrumβ-lactamases-producing Klebsiella pneumoniae isolated from selected hospitals in Malaysia

Objective:To determine the distribution,phenotypic and genetic background of extended spectrumβ-lactamases(ESBL)-producing Klebsiella(K.)pneumoniae clinical isolates associated with K1 and K2 serotypes in two selected hospitals in Malaysia.Methods:A total of 192 K.pneumoniae isolates were collected and subjected to antibiotic susceptibility,hypermucoviscosity test and multiplex PCR to detect the presence of K1-and K2-serotype associated genes.Multilocus sequence typing(MLST)was performed on ESBL-producing K.pneumoniae isolates presented with K1 and K2 serotypes,followed by phylogenetic analysis.Results:A total of 87 out of 192(45.3%)of the K.pneumoniae isolates collected were ESBL producers.However,only 8.3%(16/192)and 10.9%(21/192)of the total isolates were detected to carry K1-and K2-serotype associated genes,respectively.Statistical analysis showed that K1 and K2 capsular serotypes were not significantly associated with ESBL phenotype(P=0.196).However,they were significantly associated with hypervirulent,as demonstrated by the positive string test(P<0.001).MLST analysis revealed that ST23 as the predominant sequence type(ST)in the K1 serotype,while the ST in the K2 serotype is more diverse.Conclusions:Although the occurrence of ESBL-producing isolates among the hypervirulent strains was low,their coexistence warrants the need for continuous surveillance.MLST showed that these isolates were genetically heterogeneous.

Phenotypic Characterization of Extended Spectrum Beta-Lactamase, Class C Cephalosporinase and Carbapenemase-Producing Klebsiella Species Isolated from Patients Consulted at Four Yaounde-Based Hospitals

Background: Klebsiella spp. are bacteria of medical importance for their role in opportunistic infections which are often difficult to treat because of resistance to one or several antimicrobials. The aim of this study was to determine antimicrobial resistance due to Extended Spectrum Beta-lactamase (ESBL), Class C cephalosporinase (AmpC) and carbapenemase enzymes in Klebsiella spp. isolated from patients consulted at four hospitals. Methodology: The study was cross-sectional and descriptive. A total of 4190 non-repetitive patients specimens from 13 types of clinical specimens were analysed from February to November 2020. Two hundred and twenty-five (225) Klebsiella spp isolates were identified using API 20E and antimicrobial susceptibility testing done according to the Kirby Bauer disc diffusion method. ESBL and AmpC phenotypes were determined by the combination disc method and carbapenemases by double disc synergy method, referenced by EUCAST guidelines for the resistance testing. Results: The frequency of the species was Klebsiella pneumoniae (69%, 155/255), K. oxytoca (14%, 31/255), K. ozaenae (12%, 27/225) and K. rhinoscleromatis (5%, 11/225). Isolates were most resistant to sulphomethoxazole trimethoprim (84%, 189/225), cepaholosporins (80%, 180/225), and least resistant to carbapenems (10.7%, 24/225). Two K. oxytoca and one K. pneumoniae were resistant to all antibiotics tested. Klebsiella pneumoniae had the most multidrug resistant isolates (59.4%, 134/225). Most isolates (83.6%, 188/225) expressed at least one enzyme, while 63.6% (143/225) of the isolates expressed at least two enzymes. Some isolates were ESBL (71.6%, 161/225), carbapenemase (10.7%, 24/225) and AmpC (6.6%, 15/225) producers. Three carbapenemases (Klebsiella pneumoniae carbapenemase-KPC, Metallo-Beta Lactamase-MBL and OXA-48) were detected. Conclusion: These results revealed that resistance of Klebsiella spp. to cephalosporins is high and this may be exacerbated by co-expression of AmpC and carbapenemases aggravating associated patient morbidity and mortality. Monitoring of antimicrobial resistance of local strains is necessary for informed decisions on empirical treatment. .

Evaluation of Disk Potentiation Test (DPT) and Double Disk Synergy Test (DDST) for The Detection of Metallo-β-Lactamases (MBLs) in Clinical Isolates of Bangladesh

Objective: Increasing the emergence of Metallo-β-lactamase (MBL) producing gram-negative bacteria and their dexterous horizontal transmission demands rapid and accurate detection. This study was conducted to determine a suitable method to promptly detect MBL-producing gram-negative bacteria. Methods: A total of 103 gram-negative bacteria were identified from various clinical samples at a tertiary care hospital in Dhaka city. MBL producers were detected by two phenotypic methods, the Disk Potentiation Test (DPT) and the Double Disk Synergy Test (DDST) based on β-lactam chelator combinations where EDTA/SMA has been used as an inhibitor and Imipenem, Ceftazidime as substrates. Results: 103 isolates which were identified as Escherichia coli spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Proteus spp, Providencia spp were found to be multidrug-resistant in antibiogram test. Isolates showed complete resistance (100%) to Imipenem, Meropenem, and Amoxiclav. The highest carbapenem-resistant etiological agents were Acinetobacter spp 40 (38.8%) followed by Pseudomonas spp 27 (26.2%), Klebsiella spp 26 (25.2%), Escherichia coli 8 (7.8%), Proteus spp 1 (1%) and Providencia spp 1 (1%). DPT method detected significantly (p = 0.000009) a higher number of MBL-producers (Imipenem with 0.5 M EDTA n = 61, 59.2% & Ceftazidime with 0.5 M EDTA n = 56, 54.4%) compared to the DDST method (Imipenem -0.5 M EDTA n = 43, 41.7%, Imipenem – SMA n = 38, 36.9% & Ceftazidime -0.5 M EDTA n = 15, 14.6%). Conclusion: Pieces of evidence suggest that DPT is a more sensitive method than DDST and could be recommended for identifying MBL-producing bacteria in Bangladeshi hospitals for the proper management of patients, to reduce time constraints and treatment costs.

Characteristics of β-Lactamase Synthesis in E. coli and K. pneumanie Strains in Nosocomial Infections

Background: Recently micro-organisms that synthesize extended-spectrum β-lactamase (ESBLs) were increased. The peculiarities of ESBL synthesis of Escherichia coli and Klebsiella pneumoniae strains that cause nosocomial urinary tract infections, surgical site infections and pneumonia in surgical clinic were studied. ESBL synthesis were observed 38.9% of E. coli strains obtained from urine, 92.3% of strains obtained from surgical site infections, and 50% of strains obtained from sputum. ESBL synthesis were observed 37.5% of K. pneumoniae strains obtained from urine, 85.7% of strains obtained from surgical site infections, and 60% of strains obtained from sputum. Different levels of ESBL synthesize of E. coli and K. pneumoniae strains isolated from different pattern is discussed. Conclusion. ESBL synthesis is common in E. coli and K. pneumoniae strains, which cause nosocomial infections. The frequency of occurrence of ESBL s synthesis among of these strains depends on clinical forms of nosocomial infections.

Analysis of AmpC β-lactamase Gene in Pseudomonas aeruginosa

The gene and the amino acid sequence of the structural and regulatory region of the Pseudomonas aeruginosa with different resistance patterns were analyzed. Six strains with different resistance patterns were selected and the AmpC β-lactamase was identified. The objective gene fragment was amplified by colonies PCR. The sequences of the PCR-products were analyzed. The DNA sequence of the structural gene ampC and the regulatory genes ampR, ampD and ampE was detected. The 6 strains and the wild-type Pseudomonas aeruginosa are highly homogeneous in structural and regulatory region. Some new mutant points were found.

产AmpC酶的猪源奇异变形杆菌分离鉴定及生物学特性分析

奇异变形杆菌(Proteus mirabilis)是一种可导致多种动物感染的条件致病菌,目前有关产AmpC酶的动物源奇异变形杆菌研究较少。为探究广西某猪场母猪流产、死胎的原因,从流产猪胎肝脏中分离到病原菌,对分离株进行纯化培养、染色镜检、生化试验和16S rRNA测序确定为奇异变形杆菌,命名为GX-Y9251株。对GX-Y9251株进行药敏试验、耐药基因检测、AmpC酶基因检测、毒力基因检测、小鼠致病性试验和生物膜半定量检测。药敏试验结果显示,该菌株对8种药物敏感,对17种抗生素耐药。GX-Y9251株存在多种耐药基因,且产AmpC酶,为blaDHA基因。GX-Y9251株存在6个毒力基因,其对小鼠的半数致死量(LD50)为5.4×107CFU;具有生物被膜形成能力,为中等黏附型(++)。研究结果为奇异变形杆菌感染的防治提供了理论依据。

Multidrug resistance extended spectrum β-lactamase and AmpC producing Escherichia coli isolated from the environment of Bogor Slaughterhouse,Indonesia

To determine the multidrug resistance extended spectrum β-lactamase and AmpC (ESBL/AmpC producing) Escherichia coli (E. coli) isolated from the environment of Bogor slaughterhouse, Indonesia.MethodsA total of 35 samples from 7 locations in slaughterhouse i.e., source of water, slaughtering floor, swab of carcass area floor, swab of evisceration area floor, untreated waste water, treated waste water, drinking water for cattle were collected from March to April 2016. Presence of ESBL/AmpC producing E. coli and susceptibility testing against 8 antimicrobial agents (penicillin G, streptomycin, gentamycin, ciprofloxacin, enrofloxacin, tetracycline, trimethoprim-sulfamethoxazole, and polymyxin B) were detected by disk diffusion test according to Clinical and Laboratory Standards Institute.ResultsESBL/AmpC producing E. coli were identified in 14.3% (5/35) of the collected samples from the environment of Bogor slaughterhouse. ESBL/AmpC-producing E. coli isolates were detected in untreated waste water (n = 3), slaughtering floor (n = 1), and carcass area floor (n = 1). Most of ESBL/AmpC-producing E. coli isolates (80%) showed multidrug resistance phenotypes against at least three classes of antibiotics. The highest incidence of antibiotics resistance was against penicillin G (100.0%) and streptomycin (100.0%), followed by gentamicin (60.0%), trimethoprim-sulfamethoxazole (60.0%), tetracycline (40.0%), ciprofloxacin (40.0%), enrofloxacin (20.0%), and polymyxin B (0.0%).ConclusionsThe transmission of antimicrobial resistant bacteria into the environment may be a potential risk for human health.

Metallo-β-Lactamases:A Major Threat to Human Health

Antibiotic resistance is one of the most significant challenges facing global healthcare. Since the 1940s, antibiotics have been used to fight infections, initially with penicillin and subsequently with various derivatives including cephalosporins, carbapenams and monobactams. A common characteristic of these antibiotics is the four-memberedβ-lactam ring. Alarmingly, in recent years an increasing number of bacteria have become resistant to these antibiotics. A major strategy employed by these pathogens is to use Zn(II)-dependent enzymes, the metallo-β-lactamases (MBLs), which hydrolyse theβ-lactam ring. Clinically useful MBL inhibitors are not yet available. Consequently, MBLs remain a major threat to human health. In this review biochemical properties of MBLs are discussed, focusing in particular on the interactions between the enzymes and the functionally essential metal ions. The precise role(s) of these metal ions is still debated and may differ between different MBLs. However, since they are required for catalysis, their binding site may present an alternative target for inhibitor design.

Microbiologic and Clinical Comparison of Patients Harboring <i>Escherichia coli</i>Blood Isolates with and without Extended-Spectrum <i>β</i>-Lactamases

The clinical and microbiologic characteristics of 34 patients with extended-spectrum β-lactamase (ESBL) positive E. coli isolated from blood were compared to 66 bacteremic patients with ESBL negative E. coli, from January 2007 through December 2009. Of the 21 ESBL positive isolates available for PCR analysis, 13 were positive for CTX-M, 8 for TEM, 4 for SHV β-lactamases, with 6 possessing multiple enzymes. Twenty of 34 (59%) ESBL-positive and 41 of 66 (62%) ESBL-negative blood isolates were considered community-associated. All but one isolate in both groups had MICs of ≤1.0 μg/ml to meropenem. However, when compared to ESBL-negative isolates, ESBL-positive isolates were more frequently resistant to levofloxacin, trimethoprim/sulfamethoxazole and had higher MICs to gentamicin, tobramycin and piperacillin/tazobactam. The use of intravenous and urinary catheters was strongly associated with the isolation of E. coli bloodstream isolates in both groups of patients. Although hospital stay was similar in both groups, appropriate therapy was given in 87% of patients with ESBL positive vs. 98% of patients with ESBL negative isolates and mortality was greater for patients with ESBL positive isolates (26% vs. 17%). Since a large proportion of E. coli blood isolates were ESBL-positive and community-associated, carbapenems should be considered as initial empiric therapy for such infections in our locale.

Antimicrobial Susceptibility and Genotyping of Plasmid Mediated- Extended Spectrum β-lactamase, AmpC β-lactamase and Aminoglycoside Modifying Enzymes in Klebsiella pneumoniae

The antimicrobial susceptibility and genotyping of plasmid mediated-extended spectrum β-lactamase (ESBLs), AmpC β-lactamase (pAmpC) and aminoglycoside modifying enzymes (AMES) in Klebsiella pneumoniae isolated in Tianjin, China were investigated in the present study. Sixty strains of Klebsiella pneumoniae isolated from Huanhu Hospital were tested against 21 antimicrobial agents by Microscan MIC method, and the PCR and DNA sequencing were used to determine the genotypes of ESBLs, pAmpC and AMES. The result in antimicrobial susceptibility testing showed that all the 60 strains of bacteria tested were proved to be multi-resistant, and that of genotyping demonstrated different genotypes among these bacterial strains, in which 60 strains belonged to the TEM type; 25 strains to the CTX-M type and 54 strains to the DNA pAmpC type. The AMES genes were found in 59 strains, while the CTX-M type of ESBLs, DHA pAmpC type AMES genes were detected in 22 strains simultaneously. It concludes that the problem of drug-resistance of Klebsiella pneumoniae on hospital in Tianjin is a serious issue, and at least 3 kinds of β-lactamase and 3 AMES genes exist.

Computational Calculations of Molecular Properties and Molecular Docking of New and Reference Cephalosporins on Penicillin Binding Proteins and Various β-Lactamases

An approach of using molinspiration calculations and molecular docking on PBPs （penicillin-binding proteins） and certain β-lactamases is employed to predict the molecular properties, bioactivity and resistance of newer and reference cephalosporins. The previously synthesized cephalosporins 1-8 and reference cephalosporins were subjected to extensive evaluations by calculating the molecular properties, drug-likeness scores on the bases of Lipinski＇s rule and bioactivity prediction using the method of molinspiration web-based software. The TPSA （topological polar surface area）, OH-NH interactions, n-violation and the molinspiration Log partition coefficient （miLogP） values were also calculated. The investigated cephalosporins were subjected to molecular docking study on PBPs （lpyy） and on β-lactamases produced by S. aureus, K. pneumonia, E. coil and P. auroginosa using 1-click-docking website. Molecular properties of 1-8 recorded higher ＂FPSA than cephalexin and were lower than the reference cephalosporins and do not fulfill the requirements for Lipinski＇s rule. Bioactivities of 1-8 were predicted to be less and their docking scores on PBPs were comparable to those of the reference cephalosporins, particularly ceftobiprole. The references recorded various docking scores on the above β-lactamases and as expected, cefiobiprole recorded the lowest scores on all β-lactarnases. Cephalosporins 1-8 recorded various docking scores on β-lactamases. Molecular docking studies on PBPs and β-lactamases are considered as very useful, reliable and practical approach for predicting the bioactivity scores and to afford some information about the stability and selectivity of the newly proposed cephalosporins against β-lactamases of certain pathogenic microbes, such as P. auroginosa and MRSA, by recording the relative docking scores in comparison with those of reference cephalosporins.

Unusual metallo-β-lactamases may constitute a new subgroup in this family of enzymes

Metallo-β-lactamases (MBLs) are a family of Zn2+-dependent enzymes that have contributed strongly to the emergence and spread of antibiotic resistance. Novel members as well as variants of existing members of this family are discovered continuously, compounding their threat to global health care. MBLs are divided into three subgroups, i.e. B1, B2 and B3. The recent discovery of an unusual MBL from Serratia proteamaculans (SPR-1) suggests the presence of an additional subgroup, i.e. B4. A database search reveals that SPR-1 has only one homologue from Cronobacter sakazakii, CSA-1.These two MBLs have a unique active site and may employ a mechanism distinct from other MBLs, but reminiscent of some organophosphate-degrading hydrolases.

Identification and preliminary characterization of novel B3-type metallo-β-lactamases

Antibiotic resistance has emerged as a major global threat to human health. Among the strategies employed by pathogens to acquire resistance the use of metallo-β-lactamases (MBLs), a family of dinuclear metalloenzymes, is among the most potent. MBLs are subdivided into three groups (i.e. B1, B2 and B3) with most of the virulence factors belonging to the B1 group. The recent discovery of AIM-1, a B3-type MBL, however, has illustrated the potential health threat of this group of MBLs. Here, we employed a bioinformatics approach to identify and characterize novel B3-type MBLs from Novosphingobium pentaromativorans and Simiduia agarivorans. These enzymes may not yet pose a direct risk to human health, but their structures and function may provide important insight into the design and synthesis of a still elusive universal MBL inhibitor.

Prevalence and Risk Factors of Penicillinase-Type β-Lactamase Producing Neisseria gonorrhoeae Isolated from Patients Attending Health-Facilities in Yaounde, Cameroon

Background and Objectives: Mitigation of antibiotic resistant Neisseria gonorrhoeae has become a priority due to considerable health and economical disabilities it generates. In order to tackle the emergence of resistant Neisseria gonorrhoeae, this study aimed to determine the prevalence and risk factors of penicillinase type β-lactamase-producing Neisseria gonorrheae among patients consulting for genital infectious disorders in two health-facilities in Yaounde, Cameroon. Materials and Method: A cross-sectional descriptive and analytical study was conducted over a 3-month period, from July 2nd to October 2nd, 2022. Vaginal and urethral secretions were collected. Biochemical identification tests were performed on colonies grown on chocolate agar + polyvitex using the Api NH gallery. The detection of penicillinases was equally performed using the API NH gallery and confirmed using the antimicrobial susceptibility testing. The Minimum Inhibitory Concentrations of some antibiotics were determined using the E-Test. Results: The results showed that out of the 198 patients sampled, 16 (8.08%) were positive for Neisseria gonorrhoeae, among which 13/16 (81.25%) were penicillinase-type β-lactamase producers. Antimicrobial susceptibility testing results showed high co-resistances to antibiotics, mainly ciprofloxacin (100%), nalidixic acid (92.31%) and azithromycin (84.62%). Moreover, high Minimum Inhibitory Concentrations of ceftriaxone (ranging from 6 to 24 mg/L) was observed toward Neisseria gonorrhoeae isolates. The risk factors of the carriage of penicillinase-type β-lactamase producing Neisseria gonorrhoeae identified were: a history of Sexually Transmitted infections (p = 0.01) and unprotected sexual intercourse (p = 0.01). Conclusion: The emergence of penicillinase-type β-lactamase producing Neisseria gonorrhoeae is increasing and the situation is becoming worrisome. The identified risk factors can constitute a basic outlook to tackle resistant Neisseria gonorrhoeae, and therefore sustain antibiotic stewardship.

一株多重耐药大肠杆菌全基因组测序及其耐药性分析

为了解大肠杆菌携带的粘菌素耐药基因并筛选敏感药物,解决多重耐药和动物临床无药可选的困局,采用16S rRNA菌种全基因组测序,PCR筛查mcr-4、mcr-5、blaTEM和AmpC酶耐药基因,应用BLAST和MEGA软件进行生物信息学和系统进化树分析,并对该菌株进行了78种抗生素抗菌药物敏感性测试及4种天然植物提取物(黄藤素、黄连素、黄芩苷和博落回)的抑菌、杀菌效果试验。结果表明,从2021年(1—12月)和2022年(1—6月)猪临床腹泻病例肠道中分离鉴定的145株大肠埃希菌(Escherichia coli,E.coli)中,鉴定出1株同时携带粘菌素耐药基因(mcr-4,mcr-5)和β内酰胺酶blaTEM、AmpC基因的猪源大肠埃希氏菌临床菌株HN2149。78种抗生素药敏试验结果显示,HN2149菌株对头孢吡肟、头孢地嗪、磷霉素、头孢克肟、头孢唑林、头孢哌酮、美洛培南、头孢西丁、头孢呋辛、头孢曲松、头孢噻肟、头孢他啶、替卡西林/克拉维酸、头孢哌酮/舒巴坦、氨曲南、哌拉西林/他唑巴坦、头孢噻肟/克拉维酸、头孢唑肟、头孢美唑、头孢他啶/克拉维酸和头孢他美敏感,对其余57种抗菌药物表现为耐药。4种植物提取物的药敏结果显示,博落回对菌株HN2149的抑菌、杀菌效果较好,其余3种提取物均对该菌株无抑菌和杀菌效果。以上研究结果为猪大肠杆菌病的防控提供参考。

产超广谱β-内酰胺酶和质粒介导的AmpC酶肺炎克雷伯菌耐药性及基因型研究

目的 了解我院临床分离的肺炎克雷伯菌耐药性及超广谱β-内酰胺酶和质粒介导的AmpC酶基因型。 方法采用Microscan微生物鉴定仪、微量肉汤稀释法,测定临床分离的肺炎克雷伯菌对21种抗菌药物的敏感 性;采用聚合酶链反应(PCR)及测序技术分析超广谱β-内酰胺酶和质粒介导的AmpC酶基因型。结果 肺炎克 雷伯菌对亚胺培南全部敏感,对环丙沙星、哌拉西林／他唑巴坦、头孢他啶、头孢西丁、头孢哌酮／舒巴坦、阿莫西 林／舒巴坦、阿米卡星、头孢噻肟和头孢哌酮的耐药率分别为36.6％、38.3％、56.7％、63.4％、81.7％、86.7％、 96.6％、98.3％和98.3％,对其他药物的耐药率为100％;60株肺炎克雷伯菌全部扩增出TEM基因,有25株细 菌检出CTX-M-Ⅰ群基因,有54株细菌扩增出DHA基因,而PER和MIR(ACT-1)全部为阴性;且有21株肺炎 克雷伯菌同时携带CTX-M-Ⅰ群、DHA和TEM基因。结论我院临床分离的肺炎克雷伯菌为多重耐药菌,同时 存在CTX-M-3型超广谱β-内酰胺酶和DHA-1型质粒介导的AmpC酶,尚未发现PER型超广谱β-内酰胺酶和 MIR型质粒介导的AmpC酶。

阴沟肠杆菌质粒型AmpC酶基因的研究

目的调查阴沟肠杆菌质粒型AmpC酶基因的流行状况及基因型。方法采用ATB药敏试验板微量肉汤法,对44株临床分离的阴沟肠杆菌进行抗菌药物敏感试验,PCR方法检测DHA和ACT型AmpC酶基因。结果44株阴沟肠杆菌呈多重耐药;36株质粒AmpC酶基因阳性(81.8%),DHA和ACT-1基因阳性率分别为11.4%、79.5%,而且3株阴沟肠杆菌同时携带DHA和ACT-1基因。结论临床分离的阴沟肠杆菌多重耐药严重、质粒AmpC酶基因携带率高;阴沟肠杆菌中检出ACT-1基因为国内首次报道。

13种抗生素对产AmpC酶或同时产ESBLs细菌的体外抗菌活性

目的 了解临床下呼吸道感染常见革兰氏阴性杆菌产 Amp C酶或同时产超广谱β-内酰胺酶(ESBL s)的情况 ,检测常用 13种抗生素对这些菌株的体外抗菌活性 ,以指导临床合理选择抗生素。方法 采用酶提取物三维试验确证产 Amp C酶或同时产 ESBL s菌株 ,应用琼脂二倍稀释法测定抗生素对这些菌株的最低抑菌浓度 (MICs)。结果 从临床痰标本分离对第一、二代及一种以上第三代头孢菌素耐药的 2 2 6株常见革兰氏阴性杆菌 ,包括阴沟肠杆菌、弗氏柠檬酸杆菌、肺炎克雷伯氏菌、大肠埃希氏菌、鲍氏不动杆菌和铜绿假单胞菌 ,其中单产 Amp C酶 34株 ,同时产 Amp C酶和 ESBL s15株 ,总检出率分别为 15 .0 % (34/ 2 2 6 )、6 .6 %(15 / 2 2 6 )。无论单产 Amp C酶还是同时产 Amp C酶和 ESBL s的细菌对第三代头孢菌素、氨曲南及头孢美唑高度耐药 ,敏感率从 0～ 14 .7% ;对含 β-内酰胺酶抑制剂的复合制剂哌拉西林 /三唑巴坦、阿莫西林 /克拉维酸、头孢哌酮 /舒巴坦耐药情况亦严重 ,敏感率从 0～ 2 9.4 % ;对环丙沙星、左氧氟沙星除大肠埃希氏菌外有较高的敏感性 ,总敏感率均为 71.4 % ;而对亚胺培南高度敏感 ,仅有 1株铜绿假单胞菌耐药。单产 Amp C酶细菌对头孢吡肟、阿米卡星敏感率分别为 97.1%、6 4 .7% ,同时产 Amp C酶?

阴沟肠杆菌去阻遏持续高产AmpC酶和超广谱β-内酰胺酶(ESBLs)的检测

目的：去阻遏持续高产ＡｍｐＣ酶，或产生超广谱β－内酰胺酶（ＥＳＢＬｓ），或同时高表达这两类酶，是阴沟肠杆菌对多种β－内酰胺类抗生素耐药的主要机制。方法：建立了一种改良的酶提取物三维试验法，在常规ＮＣＣＬＳ纸片扩散法基础上接种大肠杆菌ＡＴＣＣ ２５９２２，在头孢西叮药敏纸片周围放射性切出琼脂小槽，待测菌的粗酶提取物在槽内扩散，与头孢西叮纸片扩散相交。结果：由于ＡｍｐＣ酶水解头孢西叮，出现抑菌圈内生长细菌，这一现象能被加入槽内的邻氯西林抑制，而ＥＳＢＬｓ不能水解头孢西叮，无此现象。因邻氯西林不能抑制ＥＳＢＬｓ活性，同样用头孢由松取代头抱西叮纸片，用邻氯西林抑制槽内ＡｍｐＣ酶，可测出 ＥＳＢＬｓ。使用该法检测分别产 ＡｍｐＣ酶、 ＥＳＢＬｓ的标准株和 ２４株临床分离多重耐药的阴沟肠杆菌。结果各种标准株检测无误，２４株阴沟肠杆菌中，１４株去阻遏持续高产ＡｍｐＣ酶试验阳性，４株产ＥＳＢＬｓ试验阳性，５株此两类酶检测均阳性，１株此两类酶检测均阴性，原因待分析。结论：对于阴沟肠杆菌，这种改良的酶提取物三维试验法能较好地鉴别持续高产 ＡｍｐＣ酶和 ＥＳＢＬ的阴沟肠杆菌，并适用于临床常规检验。

阴沟肠杆菌去阻遏持续高产AmpC酶和超广谱β-内酰胺酶的耐药调查

目的 了解阴沟肠杆菌去阻遏持续高产AmpC酶 ,或产超广谱β 内酰胺酶 (ESBLs)及同时表达这两类酶的现状及耐药性 ,指导医生临床用药。方法 采用改良的酶提取物三维试验法 ,检测阴沟肠杆菌去阻遏持续高产AmpC酶 ,用表型确证试验检测ESBLs,并用K B法对抗菌药物进行体外药敏试验。结果 在 6 8株阴沟肠杆菌中 ,8株持续高产AmpC酶 ,14株产ESBLs,3株同时表达这两种酶。结论 产酶菌株对抗菌药物的耐药性远远高于不产酶菌 ,且多重耐药 ,改良的酶提取物三维试验法 ,能较好地检测阴沟肠杆菌持续高产AmpC酶 ,适用于临床常规检验 ,为临床医生使用抗菌药物提供合理建议 。