中国临床药理学杂志
中國臨床藥理學雜誌
중국림상약이학잡지
THE CHINESE JOURNAL OF CLINICAL PHARMACOLOGY
2014年
10期
919-921
,共3页
曹小利%徐学静%张之烽%沈翰%宁明哲%周万青%张葵%郑波%吕媛
曹小利%徐學靜%張之烽%瀋翰%寧明哲%週萬青%張葵%鄭波%呂媛
조소리%서학정%장지봉%침한%저명철%주만청%장규%정파%려원
AmpC 酶%超广谱头孢菌素酶%碳青霉烯酶%头孢西丁%耐药性
AmpC 酶%超廣譜頭孢菌素酶%碳青黴烯酶%頭孢西丁%耐藥性
AmpC 매%초엄보두포균소매%탄청매희매%두포서정%내약성
AmpC%ESBLs%carabpenease%cefoxitin%resistance
目的：对头孢西丁不敏感肺炎克雷伯杆菌临床分离株进行耐药性分析，并对β内酰胺酶的流行情况进行调查分析。方法对非重复分离的62株头孢西丁不敏感肺炎克雷伯杆菌进行耐药性（敏感性由 K -B 法测定）分析，并与同期分离的239株头孢西丁敏感肺炎克雷伯杆菌的耐药性进行比对分析；用双纸片协同法确证测定超广谱头孢菌素酶（ESBLs）的产生情况；改良 Hodge 法初筛碳青霉烯酶；聚合酶链式反应（PCR）法和 DNA 测序法分析 AmpC 酶及肺炎克雷伯杆菌碳青霉烯酶（KPC）编码基因。结果氨苄西林除外，头孢西丁不敏感性肺炎克雷伯杆菌对几乎所测的抗菌药物耐药率均显著增高（P ＜0．05）；表型初筛检出产 ESBLs 菌55株（88．7％），产碳青霉烯酶菌39株（62．9％）。 PCR 和 DNA测序分析结果显示：产 AmpC 酶8株（12．9％），产 KPC 酶39株（62．9％）。结论我院头孢西丁不敏感肺炎克雷伯杆菌大多产 ESBLs 酶和 KPC 型碳青霉烯酶，伴有 AmpC 酶的流行，使临床抗感染治疗和院感控制面临严峻挑战。
目的：對頭孢西丁不敏感肺炎剋雷伯桿菌臨床分離株進行耐藥性分析，併對β內酰胺酶的流行情況進行調查分析。方法對非重複分離的62株頭孢西丁不敏感肺炎剋雷伯桿菌進行耐藥性（敏感性由 K -B 法測定）分析，併與同期分離的239株頭孢西丁敏感肺炎剋雷伯桿菌的耐藥性進行比對分析；用雙紙片協同法確證測定超廣譜頭孢菌素酶（ESBLs）的產生情況；改良 Hodge 法初篩碳青黴烯酶；聚閤酶鏈式反應（PCR）法和 DNA 測序法分析 AmpC 酶及肺炎剋雷伯桿菌碳青黴烯酶（KPC）編碼基因。結果氨芐西林除外，頭孢西丁不敏感性肺炎剋雷伯桿菌對幾乎所測的抗菌藥物耐藥率均顯著增高（P ＜0．05）；錶型初篩檢齣產 ESBLs 菌55株（88．7％），產碳青黴烯酶菌39株（62．9％）。 PCR 和 DNA測序分析結果顯示：產 AmpC 酶8株（12．9％），產 KPC 酶39株（62．9％）。結論我院頭孢西丁不敏感肺炎剋雷伯桿菌大多產 ESBLs 酶和 KPC 型碳青黴烯酶，伴有 AmpC 酶的流行，使臨床抗感染治療和院感控製麵臨嚴峻挑戰。
목적：대두포서정불민감폐염극뢰백간균림상분리주진행내약성분석，병대β내선알매적류행정황진행조사분석。방법대비중복분리적62주두포서정불민감폐염극뢰백간균진행내약성（민감성유 K -B 법측정）분석，병여동기분리적239주두포서정민감폐염극뢰백간균적내약성진행비대분석；용쌍지편협동법학증측정초엄보두포균소매（ESBLs）적산생정황；개량 Hodge 법초사탄청매희매；취합매련식반응（PCR）법화 DNA 측서법분석 AmpC 매급폐염극뢰백간균탄청매희매（KPC）편마기인。결과안변서림제외，두포서정불민감성폐염극뢰백간균대궤호소측적항균약물내약솔균현저증고（P ＜0．05）；표형초사검출산 ESBLs 균55주（88．7％），산탄청매희매균39주（62．9％）。 PCR 화 DNA측서분석결과현시：산 AmpC 매8주（12．9％），산 KPC 매39주（62．9％）。결론아원두포서정불민감폐염극뢰백간균대다산 ESBLs 매화 KPC 형탄청매희매，반유 AmpC 매적류행，사림상항감염치료화원감공제면림엄준도전。
Objective To analyze the resistance of clinically cefoxitin -non -susceptible Klebsiella pneumoniae isolates and the prevalence ofβ-lactamase.Methods WHONET 5.6 was used to analyze the resist-ance of 62 strains with non -susceptibility to cefoxitin recovered.Chi -square test was adopted to compare the resistance rates of 62 isolates with the 239 Klebsiella pneumoniae isolates susceptible to cefoxitin collected during the same period.Meanwhile, the 62 clinical isolates were further taken for preliminary screening for ESBLs and carbapenmase by disk -diffusion tests and modified Hodge tests, respectively.Further analysis for detecting the resistant genes encoding AmpC and carbapenemase was carried out by PCR and DNA sequencing.Results On the whole, cefoxin -non - susceptible Klebsiella pneumoniae isolates displayed higher resistances towards all the antimicrobial agents tested ( P <0.05), except for ampicilin.Preliminary screening test showed that 55 strains (88.7%) were ESBLs producers and 39 strains (62.9%) were carbapenemase producers.PCR and DNA sequencing showed that 8 (12.9%) produced AmpC and 39 (62.9%) strains produced KPC carbapenemase, respectively.Conclusion Most of the Klebsiella pneu-moniae isolates non - susceptibilitible to cefoxitin produce KPC carbapenemase and ESBLs, with AmpC being prevalent, posing a great challenge to clinical therapy and infection control.
