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目的探讨产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌(Klebsiella pneumoniae,Kp)的最佳筛选底物、发生率、耐药性及耐药基因分型,为合理用药及制定预防方案提供参考。方法收集2015年1月~2016年1月本院分离的98株肺炎克雷伯菌进行ESBLs筛选及确证,计算其发生率,比较确证结果及底物初筛结果,确定ESBLs菌株最佳筛选底物,并进行16种抗生素的药敏试验,观察产ESBLs肺炎克雷伯菌耐药性。分析产ESBLsKp质粒谱,对其携带的ESBLs耐药基因进行PCR扩增与分型。结果产ESBLs肺炎克雷伯菌分离率为25.51%,头孢噻肟是其最佳底物,灵敏度高达100%;其次为头孢曲松、氨曲南、头孢泊肟;头孢他啶作为底物时的灵敏度最低,为60.42%,且漏检率较高。产ESBLs菌对亚胺培南耐药率为0,对丁胺卡那、头孢哌酮/舒巴坦及头孢西丁的耐药率分别为20.00%、33.00%和23.00%,对其他12种抗生素均有较高耐药性。产ESBLs肺炎克雷伯菌携带的β-内酰胺酶基因型主要包括:TEM型、SHV型、非TEM及非SHV型。结论肺炎克雷伯菌对头霉素类、亚胺培南及含有β-内酰胺酶抑制复合物等药物敏感,这几类抗生素可用于治疗产ESBLs肺炎克雷伯菌感染。产ESBLsKp质粒谱多样化,除TEM型与SHV型β-内酰胺酶基因,还含有其他来源基因。
Objective To investigate the optimal screening substrates, incidence rates, drug resistance and resistance genotypes of Klebsiella pneumoniae (Kp) producing extended-spectrum β-lactamases (ESBLs) for rational use and formulation Prevention programs provide a reference. Methods 98 strains of Klebsiella pneumonia isolated in our hospital from January 2015 to January 2016 were collected for ESBLs screening and confirmation. The incidence of ESBLs was calculated, and the results of confirmatory test and substrate screening were compared to determine the optimal screening of ESBLs strains Drug susceptibility tests of 16 antibiotics were performed to observe the drug resistance of ESBLs-producing Klebsiella pneumoniae. ESBLsKp plasmids were analyzed, and their ESBLs-resistant genes were amplified by PCR and genotyped. Results The isolation rate of Klebsiella pneumoniae producing ESBLs was 25.51%. Cefotaxime was the best substrate and the sensitivity was as high as 100%. The second was ceftriaxone, aztreonam and cefpodoxime; the sensitivity of ceftazidime as substrate The lowest is 60.42%, and the missed inspection rate is higher. The resistance rate of ESBLs-producing strains to imipenem was 0, and the rates of resistance to amikacin, cefoperazone / sulbactam and cefoxitin were 20.00%, 33.00% and 23.00% Antibiotics have higher resistance. ESBLs-producing Klebsiella pneumoniae carrying β-lactamase genotypes include: TEM type, SHV type, non-TEM and non-SHV type. Conclusions Klebsiella pneumoniae is sensitive to cephamycines, imipenem and β-lactamase inhibiting compounds. These antibiotics can be used to treat Klebsiella pneumoniae producing ESBLs. Production of ESBLsKp plasmid spectrum diversity, in addition to TEM and SHV type β-lactamase gene, but also contains other sources of genes.