【摘要】 目的研究近3年分离的肺炎克雷伯菌超广谱β-内酰胺酶(ESBLs)的基因分型及耐药性变迁。方法选取用双纸片协同试验确认产ESBLs肺炎克雷伯菌145株,纸片扩散法(K-B)法检测对常用抗菌药物的耐药性,PCR法检测ESBLs基因并对阳性产物进行DNA测序及比对确认具体基因型别。结果 145株产ESBLs肺炎克雷伯菌,对头孢他啶、头孢吡肟、氨曲南耐药率逐年升高;对PCR阳性产物进行DNA测序及比对确定基因型分别为TEM、SHV型酶基因检测变化不大,而CTX-M型由以CTX-M-14型为主变迁为以CTX-M-28型为主,3年均未检测到OXA、LAP、PER、GES、SFO、VEB型ESBLs。结论近3年分离出的产ESBLs肺炎克雷伯菌基因中CTX-M型发生明显变迁,对头孢他啶、头孢吡肟、氨曲南耐药率明显升高,临床应结合耐药菌株的药物敏感试验和地方流行病学特征选择最佳的抗菌药物。更多还原

【Abstract】 OBJECTIVE To analyze the genotype and change of drug resistance in extended spectrum β-lactamase-producing Klebsiella pneumoniae in the past three years.METHODS In a total of 145 strains of ESBLs-producing K.pneumoniae,extended spectrum beta lactamases(ESBLs) were confirmed by the double disk synergy test.The antibiotics resistance were detected by disc diffusion test(K-B method) and genotype of ESBLs were detected and analyzed by polymerase chain reaction(PCR) and DNA sequencing.RESULTS There was an obvious increase for the rate of antibiotics resistance to ceftazidime,cefepime,aztreonam in a total of 145 strains of ESBLs-producing K.pneumoniae.Results of DNA sequencing indicated that the genotype was no significant change in TEM-type gene,SHV-type gene in the past three years.However,there was significant change in CTX-M genotype,in which main CTX-M gene shifted from CTX-M-14-type to CTX-M-28-type during the period from 2007 to 2009.In addition,It was not found for OXA-type,LAP-type,PER-type,GES-type,SFO-type and VEB-type ESBLs in all strains.CONCLUSION The CTX-M genotype has a predominant changing in K.pneumoniae isolated from our hospital in the past three years.Meanwhile,the antibiotics resistance rates to ceftazidime,cefepime,aztreonam of these strains have an obvious increase.So,the antimicrobial agents should be used reasonably according to the results of drug sensitivity test and local epidemiologic feature in clinic.更多还原