重庆医科大学学报
重慶醫科大學學報
중경의과대학학보
UNIVERSITATIS SCIENTIAE MEDICINAE CHONGQING
2010年
2期
304-308
,共5页
朱卫民%陈勇川%杨春%何光荣%黄文祥%郑行萍
硃衛民%陳勇川%楊春%何光榮%黃文祥%鄭行萍
주위민%진용천%양춘%하광영%황문상%정행평
肺炎克雷伯菌%超广谱 β- 内酰胺酶%AmpC%分子流行病学
肺炎剋雷伯菌%超廣譜 β- 內酰胺酶%AmpC%分子流行病學
폐염극뢰백균%초엄보 β- 내선알매%AmpC%분자류행병학
Klebsiella pneumoniae%Extended spectrum β-lactamasos%AmpC%Molecular epidemiology
目的:研究调查临床分离的120株非重复肺炎克雷伯菌中产超广谱β-内酰胺酶(Extendod spectrum β-laetamases,ESBLs)和头孢菌素酶(Amplerclass C β-lactamase,AmpC)菌株的发生率,以及ESBLs和AmpC:的表型及基因型.方法:采用美国国家临床实验室标准委员会规定的ESBLs表型,筛选和确证ESBLs的发生率.以分析性等电聚焦、接合实验确定ESBLs和AmpC菌株中酶的表型.以质粒为模板,用β-内酰胺酶通用引物、bhTEM、blaSHv及blaAmpC作PCR扩增,并以染色体为模板,用blaAmpC为引物作PCR扩增以确定酶的基因型.结果:120株非重复的肺炎克雷伯菌中,产β-内酰胺酶的有93株(77.5%),其中15株产EsBLs(12.5%),9株产AmpC(7.5%).医院感染ESBIs阳性率(25.5%)明显高于院外感染株(3.7%),所有产AmpC菌株均来自院内感染.所有菌株均对亚胺培南敏感.AmpC阳性菌株对β-内酰胺抗生素的耐药率高于AmpC阴性菌株.产ESBLs或AmpC的18株菌中有9株的编码基因可通过接合实验而转移.结论:肺炎克雷伯菌大多为产β-内酰胺酶菌株,其中产ESBLs和AmpC酶的频率较高,并常导致院内感染;其耐药质粒可通过接合转移给敏感菌,导致耐药性传播.
目的:研究調查臨床分離的120株非重複肺炎剋雷伯菌中產超廣譜β-內酰胺酶(Extendod spectrum β-laetamases,ESBLs)和頭孢菌素酶(Amplerclass C β-lactamase,AmpC)菌株的髮生率,以及ESBLs和AmpC:的錶型及基因型.方法:採用美國國傢臨床實驗室標準委員會規定的ESBLs錶型,篩選和確證ESBLs的髮生率.以分析性等電聚焦、接閤實驗確定ESBLs和AmpC菌株中酶的錶型.以質粒為模闆,用β-內酰胺酶通用引物、bhTEM、blaSHv及blaAmpC作PCR擴增,併以染色體為模闆,用blaAmpC為引物作PCR擴增以確定酶的基因型.結果:120株非重複的肺炎剋雷伯菌中,產β-內酰胺酶的有93株(77.5%),其中15株產EsBLs(12.5%),9株產AmpC(7.5%).醫院感染ESBIs暘性率(25.5%)明顯高于院外感染株(3.7%),所有產AmpC菌株均來自院內感染.所有菌株均對亞胺培南敏感.AmpC暘性菌株對β-內酰胺抗生素的耐藥率高于AmpC陰性菌株.產ESBLs或AmpC的18株菌中有9株的編碼基因可通過接閤實驗而轉移.結論:肺炎剋雷伯菌大多為產β-內酰胺酶菌株,其中產ESBLs和AmpC酶的頻率較高,併常導緻院內感染;其耐藥質粒可通過接閤轉移給敏感菌,導緻耐藥性傳播.
목적:연구조사림상분리적120주비중복폐염극뢰백균중산초엄보β-내선알매(Extendod spectrum β-laetamases,ESBLs)화두포균소매(Amplerclass C β-lactamase,AmpC)균주적발생솔,이급ESBLs화AmpC:적표형급기인형.방법:채용미국국가림상실험실표준위원회규정적ESBLs표형,사선화학증ESBLs적발생솔.이분석성등전취초、접합실험학정ESBLs화AmpC균주중매적표형.이질립위모판,용β-내선알매통용인물、bhTEM、blaSHv급blaAmpC작PCR확증,병이염색체위모판,용blaAmpC위인물작PCR확증이학정매적기인형.결과:120주비중복적폐염극뢰백균중,산β-내선알매적유93주(77.5%),기중15주산EsBLs(12.5%),9주산AmpC(7.5%).의원감염ESBIs양성솔(25.5%)명현고우원외감염주(3.7%),소유산AmpC균주균래자원내감염.소유균주균대아알배남민감.AmpC양성균주대β-내선알항생소적내약솔고우AmpC음성균주.산ESBLs혹AmpC적18주균중유9주적편마기인가통과접합실험이전이.결론:폐염극뢰백균대다위산β-내선알매균주,기중산ESBLs화AmpC매적빈솔교고,병상도치원내감염;기내약질립가통과접합전이급민감균,도치내약성전파.
Objective:To study the prevalence,phenotypes and genotypes of ESBLs and AmpC-producing 120 nonrepetitive clinical isolates of K.pneumoniae.Methods: The occurrence of phenotype producing ESBLs was screened and determined according to the National Committeefor Clinical Laboratory Standards (NCCLS).The phenotypes of β-lactamase were studied by isolectric focusing and conjugation methods.The plasmid and genomic DNA extracted from the bacteria were used to determine genotype of theβ-lactamases by PCR with bla,blaTEM,blaSHV and bla AmpC-specific primers.Results:The study showed that among 120 isolates,the β-lactamase-producing strains, ESBLs-produeing and AmpC-producing strains were 93(77.5%),15(12.5%)and 9(7.5%) isolates,respectively.The ESBLs-producing strains Were much more frequently found in nosocemial isolates (25.5%) than that in community(3.7%).And all AmpC-producing strains were found in nosocomial isolates.None of them was resistant to imipenam.Furthermore,AmpC-producing strains were found to be more resistant to antibiotics than AmpC negative strains.The encoding genes could be transferred by conjugation and were found in 9 of 18 resistant strains producing both ESBLs and AmpC.Conclusion:A high incidence of ESBLs and AmpC-producing strains existed in K.pneumoniae.These β-lactamase producing strains had been the main pathogens of nosocomial infection.Otherwise,that the gene encoding ESBLs and AmpC could be transferred to susceptible strains by conjugation leading to the resistance spreading abroad.
