中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2012年
2期
96-100
,共5页
刘小玲%彭代智%薛亮%舒文婷%周新%刘敬
劉小玲%彭代智%薛亮%舒文婷%週新%劉敬
류소령%팽대지%설량%서문정%주신%류경
烧伤%感染%克雷伯菌,肺炎%β内酰胺酶类%耐药基因
燒傷%感染%剋雷伯菌,肺炎%β內酰胺酶類%耐藥基因
소상%감염%극뢰백균,폐염%β내선알매류%내약기인
Burns%Infection%Klebsiella pneumoniae%Beta-lactamases%Drug-resistant gene
目的 了解烧伤感染患者肺炎克雷伯菌( KPN)的耐药表型及同源性. 方法 收集2007年1月-2011年6月由西南医院全军烧伤研究所(简称本研究所)住院患者创面、血液、痰液、静脉导管、大便、口腔等分离的KPN共54株,经鉴定后采用K-B纸片扩散法检测菌株对氨苄西林、替卡西林等18种临床常用抗生素的耐药性.根据菌株耐药性筛选出产超广谱β内酰胺酶(ESBL)的KPN,PCR法检测其耐药基因SHV、TEM、CTX-M阳性率,采用脉冲场凝胶电泳及聚类分析法分析菌株同源性,另对各年检出的产ESBL的KPN进行同源性分析. 结果 (1)54株KPN对亚胺培南、美罗培南和厄他培南的敏感率依次为96.30％、92.59％、81.48％,对头孢替坦、头孢西丁的敏感率为70.37％和64.81％,对头孢他啶的敏感率为57.41％,对其他抗生素的敏感率均低于40.00％.(2)共筛选出26株产ESBL的KPN,其SHV、TEM、CTX-M阳性率分别为96.15％( 25/26)、76.92％( 20/26)、57.69％ (15/26).同时携带前述3种基因的菌株检出率为42.31％ (11/26),SHV和TEM双阳性菌株检出率为34.62％( 9/26),仅携带单一基因的菌株检出率均小于10.00％.(3)产ESBL的KPN共分为9种基因型,A、B、C、D、E型分别占30.77％(8/26)、19.23％(5/26)、15.38％ (4/26)、11.54％(3/26)和7.69％( 2/26),F、G、H和Ⅰ型均分别占3.85％ (1/26).(4)2007、2010年产ESBL的KPN基因型均以A型为主,分别占2/3和1/2；2008年C、E、F型各l株；2009年以B型为主,占1/2；2011年A、D、H、Ⅰ型各l株. 结论 本研究所烧伤感染患者KPN对临床常用抗生素耐药性高,可选择碳青霉烯类药物治疗.产ESBL的KPN大部分同时携带2种或者3种耐药基因,基因型以A型为主.
目的 瞭解燒傷感染患者肺炎剋雷伯菌( KPN)的耐藥錶型及同源性. 方法 收集2007年1月-2011年6月由西南醫院全軍燒傷研究所(簡稱本研究所)住院患者創麵、血液、痰液、靜脈導管、大便、口腔等分離的KPN共54株,經鑒定後採用K-B紙片擴散法檢測菌株對氨芐西林、替卡西林等18種臨床常用抗生素的耐藥性.根據菌株耐藥性篩選齣產超廣譜β內酰胺酶(ESBL)的KPN,PCR法檢測其耐藥基因SHV、TEM、CTX-M暘性率,採用脈遲場凝膠電泳及聚類分析法分析菌株同源性,另對各年檢齣的產ESBL的KPN進行同源性分析. 結果 (1)54株KPN對亞胺培南、美囉培南和阨他培南的敏感率依次為96.30％、92.59％、81.48％,對頭孢替坦、頭孢西丁的敏感率為70.37％和64.81％,對頭孢他啶的敏感率為57.41％,對其他抗生素的敏感率均低于40.00％.(2)共篩選齣26株產ESBL的KPN,其SHV、TEM、CTX-M暘性率分彆為96.15％( 25/26)、76.92％( 20/26)、57.69％ (15/26).同時攜帶前述3種基因的菌株檢齣率為42.31％ (11/26),SHV和TEM雙暘性菌株檢齣率為34.62％( 9/26),僅攜帶單一基因的菌株檢齣率均小于10.00％.(3)產ESBL的KPN共分為9種基因型,A、B、C、D、E型分彆佔30.77％(8/26)、19.23％(5/26)、15.38％ (4/26)、11.54％(3/26)和7.69％( 2/26),F、G、H和Ⅰ型均分彆佔3.85％ (1/26).(4)2007、2010年產ESBL的KPN基因型均以A型為主,分彆佔2/3和1/2；2008年C、E、F型各l株；2009年以B型為主,佔1/2；2011年A、D、H、Ⅰ型各l株. 結論 本研究所燒傷感染患者KPN對臨床常用抗生素耐藥性高,可選擇碳青黴烯類藥物治療.產ESBL的KPN大部分同時攜帶2種或者3種耐藥基因,基因型以A型為主.
목적 료해소상감염환자폐염극뢰백균( KPN)적내약표형급동원성. 방법 수집2007년1월-2011년6월유서남의원전군소상연구소(간칭본연구소)주원환자창면、혈액、담액、정맥도관、대편、구강등분리적KPN공54주,경감정후채용K-B지편확산법검측균주대안변서림、체잡서림등18충림상상용항생소적내약성.근거균주내약성사선출산초엄보β내선알매(ESBL)적KPN,PCR법검측기내약기인SHV、TEM、CTX-M양성솔,채용맥충장응효전영급취류분석법분석균주동원성,령대각년검출적산ESBL적KPN진행동원성분석. 결과 (1)54주KPN대아알배남、미라배남화액타배남적민감솔의차위96.30％、92.59％、81.48％,대두포체탄、두포서정적민감솔위70.37％화64.81％,대두포타정적민감솔위57.41％,대기타항생소적민감솔균저우40.00％.(2)공사선출26주산ESBL적KPN,기SHV、TEM、CTX-M양성솔분별위96.15％( 25/26)、76.92％( 20/26)、57.69％ (15/26).동시휴대전술3충기인적균주검출솔위42.31％ (11/26),SHV화TEM쌍양성균주검출솔위34.62％( 9/26),부휴대단일기인적균주검출솔균소우10.00％.(3)산ESBL적KPN공분위9충기인형,A、B、C、D、E형분별점30.77％(8/26)、19.23％(5/26)、15.38％ (4/26)、11.54％(3/26)화7.69％( 2/26),F、G、H화Ⅰ형균분별점3.85％ (1/26).(4)2007、2010년산ESBL적KPN기인형균이A형위주,분별점2/3화1/2；2008년C、E、F형각l주；2009년이B형위주,점1/2；2011년A、D、H、Ⅰ형각l주. 결론 본연구소소상감염환자KPN대림상상용항생소내약성고,가선택탄청매희류약물치료.산ESBL적KPN대부분동시휴대2충혹자3충내약기인,기인형이A형위주.
Objective To study the resistance phenotype and homology of Klebsiella pneumoniae (KPN) in burn patients with infection. Methods Fifty-four strains of KPN were isolated from wound excretion,blood,sputum,venous catheter,feces,and oral cavity of patients hospitalized in Institute of Burn Research of Southwest Hospital (briefly called our institute) from January 2007 to June 2011.Drug resistance of the 54 strains of KPN to 18 antibiotics commonly used in clinic,including ampicillin,ticarcillin,etc,was tested by K-B paper disk diffusion method after being identified.Extended-spectrum β-lactamase ( ESBL)-producing KPN was screened based on the drug resistance result.The positive rates of drug-resistant genes SHV,TEM,and CTX-M of the ESBL-producing KPN were detected by polymerase chain reaction.The homology of the ESBL-producing KPN was analyzed by pulse field gel electrophoresis and clustering methodology.The homology of ESBL-producing KPN isolated in each year was analyzed too. Results ( 1 ) The sensitive rate of the 54 strains of KPN to imipenem,meropenem,and ertapenem was respectively 96.30％,92.59％,and 81.48％,that of these strains to cefotetan and cefoxitin was respectively 70.37％ and 64.81％,and that of these strains to cefiazidime was 57.41％.The sensitive rates of the 54 strains of KPN to the other antibiotics were all lower than 40.00％.(2) Twenty-six ESBL-producing KPN strains were screened and the positive rate of SHV,TEM,and CTX-M was 96.15％ (25/26),76.92％ (20/26),and 57.69％ (15/26),respectively.Detection rate of ESBL-producing KPN strains carrying three genes at the same time was 42.31％ (11/26),that of these strains carrying both SHV and TEM was 34.62％ (9/26),and those of these strains carrying only a single gene were all less than 10.00％.( 3 ) The twenty-six ESBL-producing KPN were classified into 9 gene types,with 30.77％ (8/26) in type A,19.23％ (5/26) in type B,15.38％ (4/26) in type C,11.54％ (3/26) in type D,7.69％ (2/26) in type E,and the rest four strains respectively in type F,G,H,I [3.85％ (1/26) ].(4) The major gene type of ESBL-producing KPN in the year of 2007 and 2010 was type A,respectively accounting for 2/3 and 1/2,while that in the year of 2009 was type B,accounting for 1/2.The three strains in 2008 was respectively in type C,E,and F.The four strains in 2011 was respectively in type A,D,H,I. Conclusions KPN in burn patients with infection in our institute are highly resistant to commonly used antibiotics in clinic,but carbapenems antibiotics can be used for the treatment.Most of the ESBL-producing KPN strains carry two or three drug-resistant genes,and the main gene type of them is type A.
