中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
10期
738-742
,共5页
徐艳霞%陈建丽%王和%王涛%唐熔%周茉%凌萍
徐豔霞%陳建麗%王和%王濤%唐鎔%週茉%凌萍
서염하%진건려%왕화%왕도%당용%주말%릉평
重症监护室%超广谱β-内酰胺酶%肺炎克雷伯菌%基因型%儿童
重癥鑑護室%超廣譜β-內酰胺酶%肺炎剋雷伯菌%基因型%兒童
중증감호실%초엄보β-내선알매%폐염극뢰백균%기인형%인동
Intensive Care Unit%Extended spectrum β-lactamase%Klebsiella pneumoniae%Genotype%Child
目的 了解贵阳市儿童医院儿科重症监护室(PICU)产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染的耐药基因型及其分子流行病学特征.方法 采用纸片扩散法和自动化仪器对临床分离菌株作用药敏试验,ESBLs表型确认试验采用双纸片协同法,采用PCR法检测耐药基因.结果 2013年4月至12月住院患儿分离出44株非重复肺炎克雷伯菌,检出产ESBLs肺炎克雷伯菌共29株,阳性率达65.9％.29株产ESBLs肺炎克雷伯菌对碳青酶烯类、头霉素类及喹诺酮类高度敏感,对青霉素类和第一、二代头孢菌素类耐药率均为100％;15株非产ESBLs肺炎克雷伯菌株仅对青霉素类耐药率达100％.产ESBLs肺炎克雷伯菌对9种抗生素耐药率(氨苄西林/舒巴坦79.3％、头孢唑啉100.0％、头孢呋辛100.0％、头孢孟多100.0％、头孢曲松100.0％、头孢他啶79.3％、头孢吡肟65.5％、庆大霉素41.4％、氨曲南79.3％)明显高于与非产ESBLs菌株(氨苄西林/舒巴坦13.3％、头孢唑啉6.7％、头孢呋辛20.0％、头孢孟多20.0％、头孢曲松0、头孢他啶0、头孢吡肟0、庆大霉素6.7％、氨曲南0)(x2=17.54、35.51、28.00、28.00、44.00、24.93、17.30、4.18、24.93,P均＜0.05).29株产ESBLs肺炎克雷伯菌共检出3种ESBLs耐药基因,检出率最高的是SHV型[93.1％(27/29株)],其次是TEM型和CTX-M型,分别占51.7％(15/29株)和37.9％(11/29株).29株产ESBLs肺炎克雷伯菌基因型分布有5种形式:14株携带单一ESBLs基因,占48.3％;5株同时携带2种基因型,占17.2％;9株携带3种基因型,占31.0％;1株未能分型.结论 产ESBLs肺炎克雷伯菌已在贵阳市儿童医院PICU广泛流行,且具有多重耐药性,其耐药基因型已出现多样化的特征.
目的 瞭解貴暘市兒童醫院兒科重癥鑑護室(PICU)產超廣譜β-內酰胺酶(ESBLs)肺炎剋雷伯菌感染的耐藥基因型及其分子流行病學特徵.方法 採用紙片擴散法和自動化儀器對臨床分離菌株作用藥敏試驗,ESBLs錶型確認試驗採用雙紙片協同法,採用PCR法檢測耐藥基因.結果 2013年4月至12月住院患兒分離齣44株非重複肺炎剋雷伯菌,檢齣產ESBLs肺炎剋雷伯菌共29株,暘性率達65.9％.29株產ESBLs肺炎剋雷伯菌對碳青酶烯類、頭黴素類及喹諾酮類高度敏感,對青黴素類和第一、二代頭孢菌素類耐藥率均為100％;15株非產ESBLs肺炎剋雷伯菌株僅對青黴素類耐藥率達100％.產ESBLs肺炎剋雷伯菌對9種抗生素耐藥率(氨芐西林/舒巴坦79.3％、頭孢唑啉100.0％、頭孢呋辛100.0％、頭孢孟多100.0％、頭孢麯鬆100.0％、頭孢他啶79.3％、頭孢吡肟65.5％、慶大黴素41.4％、氨麯南79.3％)明顯高于與非產ESBLs菌株(氨芐西林/舒巴坦13.3％、頭孢唑啉6.7％、頭孢呋辛20.0％、頭孢孟多20.0％、頭孢麯鬆0、頭孢他啶0、頭孢吡肟0、慶大黴素6.7％、氨麯南0)(x2=17.54、35.51、28.00、28.00、44.00、24.93、17.30、4.18、24.93,P均＜0.05).29株產ESBLs肺炎剋雷伯菌共檢齣3種ESBLs耐藥基因,檢齣率最高的是SHV型[93.1％(27/29株)],其次是TEM型和CTX-M型,分彆佔51.7％(15/29株)和37.9％(11/29株).29株產ESBLs肺炎剋雷伯菌基因型分佈有5種形式:14株攜帶單一ESBLs基因,佔48.3％;5株同時攜帶2種基因型,佔17.2％;9株攜帶3種基因型,佔31.0％;1株未能分型.結論 產ESBLs肺炎剋雷伯菌已在貴暘市兒童醫院PICU廣汎流行,且具有多重耐藥性,其耐藥基因型已齣現多樣化的特徵.
목적 료해귀양시인동의원인과중증감호실(PICU)산초엄보β-내선알매(ESBLs)폐염극뢰백균감염적내약기인형급기분자류행병학특정.방법 채용지편확산법화자동화의기대림상분리균주작용약민시험,ESBLs표형학인시험채용쌍지편협동법,채용PCR법검측내약기인.결과 2013년4월지12월주원환인분리출44주비중복폐염극뢰백균,검출산ESBLs폐염극뢰백균공29주,양성솔체65.9％.29주산ESBLs폐염극뢰백균대탄청매희류、두매소류급규낙동류고도민감,대청매소류화제일、이대두포균소류내약솔균위100％;15주비산ESBLs폐염극뢰백균주부대청매소류내약솔체100％.산ESBLs폐염극뢰백균대9충항생소내약솔(안변서림/서파탄79.3％、두포서람100.0％、두포부신100.0％、두포맹다100.0％、두포곡송100.0％、두포타정79.3％、두포필우65.5％、경대매소41.4％、안곡남79.3％)명현고우여비산ESBLs균주(안변서림/서파탄13.3％、두포서람6.7％、두포부신20.0％、두포맹다20.0％、두포곡송0、두포타정0、두포필우0、경대매소6.7％、안곡남0)(x2=17.54、35.51、28.00、28.00、44.00、24.93、17.30、4.18、24.93,P균＜0.05).29주산ESBLs폐염극뢰백균공검출3충ESBLs내약기인,검출솔최고적시SHV형[93.1％(27/29주)],기차시TEM형화CTX-M형,분별점51.7％(15/29주)화37.9％(11/29주).29주산ESBLs폐염극뢰백균기인형분포유5충형식:14주휴대단일ESBLs기인,점48.3％;5주동시휴대2충기인형,점17.2％;9주휴대3충기인형,점31.0％;1주미능분형.결론 산ESBLs폐염극뢰백균이재귀양시인동의원PICU엄범류행,차구유다중내약성,기내약기인형이출현다양화적특정.
Obgective To explore the antimicrobial resistance genotypes and molecular epidemic features of Klebsiella pneumoniae (K.pneumoniae) producing extended spectrum 3-lactamases (ESBLs) in the Pediatric Intensive Care Unit (PICU) of Guiyang Children' s Hospital.Methods Disc diffusion technique (Kirby-Bauer method) and automatic microbiology analysis system were employed to determine the antimicrobial resistance,and Double-disk Diffusion was adopted in the phenotype confirmatory test of ESBLs,and PCR was used to determine the antimicrobial resistance genotypes.Results Among 44 straits of non-repetitive-K.pneumoniae,isolated from the children during hospitalization since April to December of 2013,29 straits (65.9％) were detected.The findings of sensitivity tests showed that 29 strains of ESBLs-producing K.pneumoniae presented a higher rate of sensitivity to carbapenems,cephamycin and quinolones,100％ resistance to penicillin and cephalosporins of the first and the second generations.Fifteen non-ESBLs-producing K.pneumoniae presented 100％ resistance to penicillin.The rate of resistance to 9 kinds of antibiotics (Ampicillin/Sulbactam,Cefazolin,Cefuroxime,Cefamandole,Cefiriaxone,Ceftazidime,Cefepime,Gentamicin,Aztreonam) in ESBLs-producing K.pneumoniae strains(79.3％,100.0％,100.0％,100.0％,100.0％,79.3％,65.5％,41.4％,79.3％) was significantly higher than that of non-ESBLs-producing K.pneumoniae trains (13.3％,6.7％,20.0％,20.0％,0,0,0,6.7％,0) (x2 =17.54,35.51,28.00,28.00,44.00,24.93,17.30,4.18,24.93,all P ＜ 0.05).In 29 strains of ESBLs-producing K.pneumoniae,3 genotypes were detected respectively:93.1％ of SHV (27/29 strains),51.7 ％ of TEM (15/29 strains) and 37.9 ％ of CTX-M (11/29 strains).Five forms of genotype distribution were presented:14 (43.8％) strains carrying single ESBLs gene,5 (17.2％) strains carrying 2 types,19 (31.0％) strains carrying 3 types,and 1 strain had not been genotyped.Conclusions ESBLs-producing K.pneumoniae had been epidemic in PICU of Guiyang Children's Hospital,with multiple antimicrobial resistances and diversification of antimicrobial resistance genotypes.
