呼吸重症监护室产质粒介导AmpC酶和ESBLs细菌的耐
药性及基因型
姚丽英;李国保;李沛;陆坚
【期刊名称】《中国感染控制杂志》 【年(卷),期】2011(010)002
【摘要】目的 了解深圳地区2所三级综合医院呼吸重症监护室(RICU)分离的革兰阴性(G-)菌产AmpC酶和超广谱β-内酰胺酶(ESBLs)情况及其耐药性与基因型特征.方法 选择分离自上述2所医院RICU的对第一、二代及1种以上第三代头孢菌素耐药的大肠埃希菌和肺炎克雷伯菌,采用纸片扩散法及E-test进行药敏试验,酶提取物三维试验检测单产ampC酶,美国临床实验室标准化研究所(CLSI)推荐的表型筛选和确证试验检测产ESBLs菌株,聚合酶链反应(PCR)通用引物扩增AmpC酶和ESBLs基因及其序列测定以确定基因亚型.结果 检出单产AmpC酶、单产ESBLs、合产AmpC酶和ESBLs的菌株分别为9株(9.38%)、52株(54.17%)和10株(10.42%).单产AmpC酶菌株对头孢吡肟和亚胺培南具有较高的敏感性,耐药率分别为33.33%和0.00%;单产ESBLs菌株对亚胺培南、哌拉西林/他唑巴坦及头孢哌酮/舒巴坦的敏感性较高,耐药率分别为0.00%、34.62%和19.23%;合产AmpC酶和ESBLs的菌株仅对亚胺培南敏感,未发现耐药株.检出AmpC酶基因型为DHA-1和ACT-1,分别占76.92%和26.08%;ESBLs基因型为CTX-M系列和SHV-5,分别占96.77%和3.23%.结论 该2所综合医院RICU存在产质粒介导DHA-1、ACT-1型AmpC酶和CTX-M、SHV型ESBLs的G-菌流行株,其对大多数新型广谱β-内酰胺类抗生素耐药,对亚胺培南敏感,值得
临
床
关
注
.%Objective
To
investigate
antimicrobial
resistance,genotypies and the prevalence of AmpC β-lactamases-producing and extended-spectrum β-lactamases (ESBLs)-producing gram-negative strains from specimens of respiratory intensive care units(RICUs) in 2 hospitals of Shenzhen. Methods A total of 96 multidrug-resistant Escherichia coli and Klebsiella pneumoniae strains were detected by three-dimensional test for AmpC β-lactamases and phenotypic confirmatory test based on Clinical and Laboratory Standard Institute (CLSI) criteria for ESBLs. Antimicrobial susceptibility of AmpC β-iactamases- and ESBLs-producing strains was detected by Kirby-Bauer and E-test methods. Universal primer PCR for AmpC βlactamases and ESBLs gene amplification and DNA sequencing were carried out for genotyping of these β-lactamases. Results AmpC β-lactamases, ESBLs and AmpC βlactamases combined with ESBLs-producing strains were found in 9(9. 38％), 52(54. 17％)and 10 (10. 42％) strains,respectively.AmpC β-lactanases -producing strains were more susceptible to cefepime and imipenem, the resistant rate being 33. 33％ and 0. 00％ respectively. ESBLs-producing strains were more susceptible to imipenem, piperacillin/tazobactam and cefoperazone/sulbactam, the resistant rate being 0. 00％, 34. 62％ and 19. 23％ respectively. AmpC β-lactamases combined with ESBLs-producing strains were only sensitive to imipenem and no imipenem-resistant one was found. The genotypes of AmpC β-lactamases were DHA- 1 and ACT- 1, the incidence being 76.
92％ and 26. 08％ respectively. ESBLs genotypes were CTX-M series and SHV-5, the incidence being 96. 77％ and 3. 23％ respectively.Conclusion There are epidemic strains of plasmid-mediafed DHA-1 ,ACT-1 type AmpC β-lactamases and CTX-M,SHV type ESBLs-producing gram-negative strains in RICUs in two hospitals, they are resistant to most new broadspectrum β-lactam antibiotics, but sensitive to imipenem. 【总页数】5页(92-96)
【关键词】重症监护室;医院感染;大肠埃希菌;肺炎克雷伯菌;AmpC酶;超广谱β-内酰胺酶;耐药基因;抗药性,微生物 【作者】姚丽英;李国保;李沛;陆坚
【作者单位】深圳市福田人民医院,广东,深圳,518033;深圳市第三人民医院,广东,深圳,518020;深圳市第三人民医院,广东,深圳,518020;深圳市第三人民医院,广东,深圳,518020 【正文语种】中文 【中图分类】R969.3 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-infection-control_thesis/0201233873164.html 【相关文献】
1.呼吸重症监护室常见细菌产AmpC酶和超广谱β-内酰胺酶的检测及耐药性研究 [J], 李国保; 李沛; 陆坚
2.新生儿重症监护室医院感染产 ESBLs 菌株的临床特点及耐药性分析 [J], 赖基
呼吸重症监护室产质粒介导AmpC酶和ESBLs细菌的耐药性及基因型
