摘要
目的了解儿童重症感染中产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌(KP)耐药及耐药基因型分布。方法收集重症监护病房常规分离的KP,双纸片协同试验进行产ESBLs检测,微量肉汤稀释法进行药敏检测,聚合酶链反应技术(PCR)检测产ESBLs菌株的耐药基因intl 1、acc、ampC、CTX-M1、CTX-M3、DHA1、OXA、shv、tem、NDM、DHA1、fox、per。结果共分离KP 143株,来源以呼吸道标本为主,占81.8%,其中痰标本73.4%。78株产ESBLs KP对24种抗生素呈现不同程度的耐药,氨苄西林、头孢唑啉和哌拉西林的耐药率达100%;氨曲南、头孢曲松和四环素耐药率达74%以上;阿米卡星、多尼培南、厄他培南、美罗培南、替加环素和呋喃妥因敏感率均为100%,检出1株亚胺培南耐药KP株。耐药基因检测显示,DHA1、Shv、Tem、CTX-M1、CTX-M3和Intl1均有不同程度检出,Shv检出率高达87.2%;携带2种、3种和4种以上耐药基因的菌株分别占30.7%、62.8%和24.4%。结论儿童重症感染KP产ESBLs率高,多重耐药模式复杂。
Objective To understand the distribution of drug resistance and genotype of extended-spectrumβ-lactamase(ESBL)-producing Klebsiella pneumoniae(KP)in children with severe infection.Methods KP routinely separated in intensive care unit was collected,and ESBLs detection was conducted by double-paper cooperative test.Drug sensitivity detection was conducted by microbroth dilution method,and drug resistance genes including intl 1,acc,ampC,CTX-M1,CTX-M3,DHA1,OXA,shv,tem,NDM,DHA1,fox and per were detected by polymerase chain reaction(PCR).Results A total of 143 KP strains were isolated mainly from respiratory specimens(81.8%),73.4%of which were sputum specimens.The 78 strains of ESBLs KP showed varying degrees of resistance to 24 antibiotics,and the rates of resistance to ampicillin,cefazolin and piperacillin were up to 100%.The rate of resistance to aztreonam,ceftriaxone and tetracycline were over 74%.The rates of sensitivity to amikacin,donipenem,ertapenem,meropenem,tigecycline and nitrofurantoin were all 100%,and one KP strain resistant to imipenem was detected.The drug resistance gene test showed that DHA1,Shv,Tem,CTX-M1,CTX-M3 and Intl1 were all detected to varying degrees,and the detection rate of Shv was as high as 87.2%.Strains with 2,3 and≥4 resistant genes accounted for 30.7%,62.8%and 24.4%,respectively.Conclusion The rate of ESBLs producing KP in severe infection children is high and the pattern of multidrug resistance is complex.
作者
邱海燕
吴军华
QIU Haiyan;WU Junhua(Ningbo Women and Children’s Hospital,Ningbo 315012,Zhejiang,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2020年第10期757-759,共3页
Journal of Clinical Pediatrics
基金
宁波市自然科学基金(No.2012A610235,No.2018A610252)。
关键词
肺炎克雷伯菌
超广谱Β-内酰胺酶
耐药基因
儿童
Klebsiella pneumoniae
extended spectrumβ-lactamase
drug resistance gene
child
作者简介
通信作者:吴军华,电子信箱:wudata@163.com。
