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目的分析儿科住院患者肺炎克雷伯菌分离株对抗生素的耐药性以及β-内酰胺酶的流行情况。方法采用全自动生化鉴定和药敏系统对细菌分离株进行鉴定和耐药性分析,用PCR法对β-内酰胺酶基因进行检测,并用DNA测序法确定其基因型。结果共收集肺炎克雷伯菌150株,主要分离自痰液(42.7%)、尿液(18.0%)、血液(14.7%)和胸水(12.7%)。耐药性分析结果表明,分离菌株对头孢菌素类、氟喹诺酮类和氨基糖苷类等临床常用抗生素均有较高程度的耐药性,对β-内酰胺酶的检测发现4种基因型,分别为blaCTX-M(47.3%)、blaSHV(38.7%)、blaTEM(31.3%)和blaDHA(3.3%),99.3%被超广谱β-内酰胺酶阳性的菌株所携带,且携带两种以上β-内酰胺酶基因型的菌株比例达44%。结论儿科住院患者分离的肺炎克雷伯菌对临床常用抗生素表现出耐药性,并携带多种β-内酰胺酶基因型,儿科临床应注重合理应用抗生素,严格控制相关病原菌的医院感染及传播。
Objective To analyze the antibiotic resistance of Klebsiella pneumoniae isolates and the prevalence of β-lactamase in pediatric inpatients. Methods The biochemical and drug sensitive systems were used to identify and analyze the bacterial isolates. The β-lactamase gene was detected by PCR and its genotype was determined by DNA sequencing. Results A total of 150 strains of Klebsiella pneumoniae were collected and mainly isolated from sputum (42.7%), urine (18.0%), blood (14.7%) and pleural effusion (12.7%). Drug resistance analysis showed that the isolated strains of cephalosporins, fluoroquinolones and aminoglycosides clinically used antibiotics have a higher degree of resistance, detection of β-lactamase found four genotypes, (47.3%), blaSHV (38.7%), blaTEM (31.3%) and blaDHA (3.3%) respectively, 99.3% of which were carried by extended-spectrum β-lactamase-positive strains and carried more than two The ratio of β-lactamase genotype strains was 44%. Conclusions Klebsiella pneumoniae isolated from pediatric inpatients showed resistance to commonly used antibiotics and carried a variety of β-lactamase genotypes. Pediatric clinical should pay attention to the rational use of antibiotics and strictly control the nosocomial infection and transmission of related pathogens .