摘要
目的 探讨耐碳青霉烯类肺炎克雷伯菌的耐药机制,并进行同源性分析。方法 选择2010年1月-2014年12月189株耐碳青霉烯类肺炎克雷伯菌株进行分析,采用Hodge方法测定碳青霉烯酶表型,采用B-last方法测定超广谱β内酰胺酶、PCR进行耐药基因测序,REP-PCR方法进行同源性分析。结果 189株菌株对厄他培南、头孢噻肟、头孢他啶、亚胺培南、阿莫西林/克拉维酸、氨曲南、美洛培南、头孢西丁的耐药率均超过90%。对米诺环素的耐药率相对较低,对替加环素的耐药率为0。改良Hodge法检测碳青霉烯酶阳性率79.9%,广谱β-内酰胺酶检测阳性率54.0%。KPC基因阳性率60.3%,IMP基因阳性率3.7%;Amp-C酶基因阳性率12.7%;162株blaSHV阳性,阳性率85.7%,其中blaSHV-11为优势基因;120株blaTEM阳性,其中blaTEM-1为优势基因;90株blaCTM-M阳性,其中blaCTM-M-14为优势基因。同源性分析结果显示G型比例最高,占55.0%,其次为J型,占16.4%。结论 耐碳青霉烯类肺炎克雷伯菌耐药机制复杂,以G型克隆株为主。临床工作中应根据药敏结果规范使用抗菌药物。
Objective To analyze resistance mechanisms and homology of carbapenem-resistant Klebsiella pneumoniae.Methods From January 2010 to December 2014, 189 carbapenem-resistant Klebsiella pneumoniaes were analyzed,carbapenemases phenotype by Hodge, ESBLs was tested by B-last, resistance gene sequencing was tested by PCR, homologous points was detected by REP-PCR. Results Resistance rates of 189 strains to ertapenem, cefotaxime, ceftazidime, imipenem, amoxicillin/clavulanic acid, aztreonam, meropenem, cefoxitin were more than 90%. Resistance rate to minocycline was low, and to tigecycline was 0. Carbapenemases phenotype positive rate by Hodge was 79.9%,and ESBLs was 54.0%. KPC gene positive rate was 60.3%;IMP was 3.7%; Amp-C was 12.7%; 162 strains of blaSHVwas positive, accounting on 85.7%, and blaSHV-11 was dominant gene; 120 strains of blaTEMwas positive, and blaTEM-1was dominant gene; 90 strains of blaCTM-Mwas positive, and blaCTM-M-14 was dominant gene. Homology analysis showed that G-type was the highest proportion of 55.0%, followed by J-type, accounting for 16.4%. Conclusion Resistance mechanisms of carbapenem-resistant Klebsiella pneumoniae is complex, and G-type clone is main clone. The use of antibiotics should be based on susceptibility results.
出处
《中国现代医生》
2015年第27期16-19,共4页
China Modern Doctor
基金
浙江省宁波市医学科技计划项目(2013A19)
