产AmpC酶的克雷伯菌药敏结果分析及质粒介导的A.docVIP

　　产AmpC酶的克雷伯菌药敏结果分析及质粒介导的A 【摘要】 目的 了解克雷伯菌的耐药性及产AmpC菌株同时产ESBLs药敏的变化。方法 采用Vitek 60型和Vitek 32型、纸片扩散法(KB法)测定42株产AmpC酶同时产ESBLs克雷伯菌的药敏结果，并与24株产AmpC酶但不产ESBLs克雷伯菌和138株不产AmpC酶但产ESBLs的克雷伯菌药敏结果对比分析；采用PCR分析产AmpC酶但不产ESBLs肺炎克雷伯菌的AmpC基因型。结果 产AmpC不管是否产ESBLs的克雷伯菌对亚胺培南敏感，对其他抗生素均有不同程度的耐药；单纯产ESBLs时，第四代头孢菌素如头孢吡肟对其活性较好，但产AmpC酶同时产ESBLs时，令头孢吡肟几乎失去活性。肺炎克雷伯菌产AmpC酶但不产ESBLs的20株菌中7株检出blaDHA基因，占35%，1株检出blaMIR基因，占5%。另外同时产AmpC酶和ESBLs的20株肺炎克雷伯菌中100%检出blaTEM基因，90%检出blaCTXM1基因，100%检出blaSHV基因，85%检出blaDHA基因，15%检出blaMIR基因，90%检出不同的氨基糖苷类修饰酶基因。结论 克雷伯菌产AmpC酶和同时产ESBLs的耐药性比单纯产AmpC酶的耐药性更高、更显著；肺炎克雷伯菌产AmpC酶的主要基因型为DHA，对同时存在2～6种不同类型耐药基因的克雷伯菌，碳青霉烯类药物亚胺培南的体外活性最好。 【关键词】 克雷伯菌 耐药基因 AmpC ESBLs ABSTRACT Objective To investigate the drug resistance of Klebsiella and the durg susceptibilitiy variation of ESBLs and AmpC simultaneouslyproducing stains. Methods The drug susceptibility of 42 AmpC and ESBLs producing Klebsiella otheds, Vitek 60 and Vitek 32 method. And the results pC but nonproducing ESBLs and those of 138 Klebsiella producing ESBLs but nonproducing AmpC. The genotypes of AmpC pCproducing Klebsiella ipenem and different degree of resistance to other tested antibiotics. The fourth generation of cephlosporin such as cefepime had potent activities to Klebsiella, but had little activity against Klebsiella simultaneouslyproducing AmpC and ESBLs. Of 20 strains of Klebsiella producing AmpC but nonproducing ESBLs, 7 strains plified in 20 strains (100%), blaCTXM1 genes ined in 2 strains (10%), blaDHA genes in 17 strains (85%), blaMIR genes in 3 strains (15%) and three types of AMEsencoding genes icrobial resisitant rates of Klebsiella simutaneoulyproducing AmpC and ESBLs are higher than that to Klebsiella producing AmpC but nonproducing ESBLs. The genotypes of Klebsiella producing AmpC are mainly DHA type. Imipenem is the first choice of the antibiotics against Klebsiella carrying 2～6 kinds of resistance genes in clinic. KEY 类和SHV类，分别由blaTEM1、blaTEM2和blaSHV1基因发生单个点突变或多个点突变，导致1个或多个氨基酸改变而来［1］。自1983年德国首先发现产E