CAJ | 학술논문

目的：分析该院临床分离的可疑产碳青霉烯酶肺炎克雷伯菌和大肠埃希菌的耐药性与耐药机制。方法采用VITEK-2全自动细菌鉴定仪检测其对21种抗菌药物的药敏结果，采用改良 Hodge试验进行碳青霉烯酶筛选，用聚合酶链反应检测碳青霉烯酶KPC基因、外膜孔道蛋白（OmpK35和OmpK36）编码基因、转座子tnpA、tnpU基因。结果47株可疑产碳青霉烯酶肺炎克雷伯菌和大肠埃希菌对青霉素类、头孢菌素类、喹诺酮类抗菌药物的耐药率高达80％以上，对亚胺培南、美罗培南、丁胺卡那霉素耐药率为35％以下；耐亚胺培南菌株对头孢哌酮/舒巴坦、头孢美唑、头孢替坦、头孢吡肟、哌拉西林/他唑巴坦、庆大霉素、妥布霉素、美罗培南、厄他培南的耐药率明显高于敏感菌株，二者差异具有统计学意义（P＜0．05）；改良 Hodge试验阳性6株，检出碳青霉烯酶KPC基因4株，符合率为66．67％，均为KPC-2型；膜孔蛋白OmpK35、OmpK36基因缺失率分别为38．30％、65．96％；转座子tnpA、tnpU检出率分别为4．25％和38．30％。结论产碳青霉烯酶并非菌株耐碳青霉烯类药物的主要原因，尚存在其他耐药机制。
목적：분석해원림상분리적가의산탄청매희매폐염극뢰백균화대장애희균적내약성여내약궤제。방법채용VITEK-2전자동세균감정의검측기대21충항균약물적약민결과，채용개량 Hodge시험진행탄청매희매사선，용취합매련반응검측탄청매희매KPC기인、외막공도단백（OmpK35화OmpK36）편마기인、전좌자tnpA、tnpU기인。결과47주가의산탄청매희매폐염극뢰백균화대장애희균대청매소류、두포균소류、규낙동류항균약물적내약솔고체80％이상，대아알배남、미라배남、정알잡나매소내약솔위35％이하；내아알배남균주대두포고동/서파탄、두포미서、두포체탄、두포필우、고랍서림/타서파탄、경대매소、타포매소、미라배남、액타배남적내약솔명현고우민감균주，이자차이구유통계학의의（P＜0．05）；개량 Hodge시험양성6주，검출탄청매희매KPC기인4주，부합솔위66．67％，균위KPC-2형；막공단백OmpK35、OmpK36기인결실솔분별위38．30％、65．96％；전좌자tnpA、tnpU검출솔분별위4．25％화38．30％。결론산탄청매희매병비균주내탄청매희류약물적주요원인，상존재기타내약궤제。
Objective To investigate the drug resistance and the resistant mechanism of suspicious carbapenemases in Klebsiella pneumoniae and Escherichia coli clinical isolates.Methods All bacteria were isolated from the First Affiliated Hospital of Guang-zhou Medical College,and antimicrobial susceptibility was done by VITEK-2 automatic bacterium identifying and drug sensitivity analyzing systems.The screening of the carbapenemase was detected by the modified Hodge test,and the polymerase chain reaction (PCR)was carried out to amplify carbapenem hydrolyzing gene(KPC),outer membrane protein genes (OmpK35 and OmpK36), transposon tnpA and tnpU.Results Among 47 strains of suspicious carbapenemases in Klebsiella pneumoniae and Escherichia coli,the higher drug resistance rates to them were penicillins,cephalosporins and quinolones,which were more than 80%.The resist-ance rates for imipenem,meropenem and amikacin were less than 35%.In addition to the imipenem-resistant strains,the resistance rates to cefoperazone/sulbactam,cefmetazole,cefotetan,cefepime,piperacillin/tazobactam,gentamicin,tobramycin,meropenem and ertapenem were significantly higher than the sensitive strains(P<0.05).6 strains were positive in the modified Hodge test,with 4 strains carried out KPC-2 gene,and the correspondence rate of 66.67%.The absence rates of outer membrane protein genes (OmpK35 and OmpK36)were 38.30% and 65.96%,respectively.The positive rates of transposition tnpA and tnpU accounted for 4.25% and 38.30%,respectively.Conclusion The emergence of carbapenemase is not the main reason of carbapenem-resistance producers in bacteria,and there may be other resistant mechanisms to reduced susceptibility of carbapenems.