近年来肺炎克雷伯菌的耐药情况
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[摘要] 目的：研究近年来肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的现象及耐药情况。方法：菌种鉴定及药敏实验标本按常规培养分离，用常规方法鉴定药敏实验，ESBLs测定采用复合表型确证法。结果：2007年，肺炎克雷伯菌产ESBLs的比率已达到32.4%；本实验室未见到对IMP耐药的菌株。结论：肺炎克雷伯菌中产ESBLs的菌株有逐年增多的趋势，且对大多数抗生素的耐药率也呈现递增的现象。
[关键词] 肺炎克雷伯菌；耐药；ESBLs
[中图分类号]R378 [文献标识码] B[文章编号] 1673-7210(2009)02(b)-128-02
The phenomenon of drug-resistance about K.pneumoniae in recent years
YAO Shu-ke1, XU Min2
(1.The First People's Hospital of Pingdingshan, Henan Province, Pingdingshan 467000, China; 2.The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)
[Abstract] Objective: To explore the tendency of producing ESBLs (extended spectrum beta-lactamases, ESBLs) and drug-resistance about K.pneumoniae in recent years. Methods: The specimens utilized in identification of bacteria species and test of drug-resistance were acquired through routine culturing and separating, the test of drug-resistance was performed in usual manner, and the strain of ESBLs was confirmed according to complex phenotype. Results: The ratio of K.pneumoniae had reached 32.4% until 2007, and the strain resistant to IMP had not been found in our laboratory. Conclusion: In K.pneumoniae, the amount of the strains producing ESBLs shows a tendency of increasing gradually, meanwhile, the rate of drug-resistance to many antibiotics is also increasing.
[Key words] K.pneumoniae; Drug-resistance; ESBLs
随着广谱抗生素的大量应用，细菌的耐药问题日趋严重。超广谱β-内酰胺酶(extended spectrum beta-lactamases，ESBLs)是由质粒介导的能使细菌对第三代头孢菌素类、青霉素类及单酰胺类抗生素耐药的一类酶，ESBLs主要由肠杆菌科细菌产生，以肺炎克雷伯菌为代表菌属。产超广谱β-内酰胺酶菌株广泛流行，给临床治疗带来很大困难。为了解本地区肺炎链球菌ESBLs的流行情况，笔者对307株肺炎链球菌进行了检测，以便采取有效措施加以控制。
1 材料与方法
1.1 菌株来源
307株肺炎克雷伯菌分离于我院2003～2007年住院患者送检的痰液、尿液、血液、咽拭子、浆膜腔液、脓性分泌物等标本。患者入院时送检标本中均未检出肺炎克雷伯菌，入院后发生肠炎、肺炎、尿道感染、创伤感染或败血症等。
1.2 抗生素
头孢唑啉(CFZ)、头孢噻肟(CTX)、头孢他啶(CAZ)、头孢吡肟(FEP)、头孢曲松(CRO)、头孢哌酮(CFP)、亚胺培南(IMP)、庆大霉素(GEN)、阿米卡星(AMK)、环丙沙星(CIP)、头孢哌酮-舒巴坦(SCF)均购自Oxiod公司。
1.3 ESBLs测定
采用复合纸片表型确证法。选用经头孢噻肟(CTX)及头孢他啶(CAZ)等三代头孢纸片初筛试验疑为产ESBLs株者，再用CAZ(30 μg)、CAZ/CLA(30 μg/10 μg)及CTX(30 μg)、CTX/CLA(30 μg/10 μg)两组纸片同时测定，接种方法按纸片扩散法进行。结果判定按美国临床实验室标准化委员会(NCCLS)的标准，即加克拉维酸和不加克拉维酸纸片的直径之差≥5 mm可确认为ESBLs菌株。
1.4 菌种鉴定
菌种鉴定与药敏试验标本按常规培养分离，用常规方法鉴定药敏试验 ......
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