临床分离产AmpCβ┐内酰胺酶阴沟肠杆菌耐药性分析.docVIP

临床分离产AmpCβ┐内酰胺酶阴沟肠杆菌耐药性分析 　 作者：凌保东 余娴 谢勇恩 雷军 【摘要】 　　目的 研究我院临床分离阴沟肠杆菌的产AmpC酶耐药情况及ampC基因型。 方法 收集临床分离的耐药阴沟肠杆菌15株;检测产AmpC酶和超广谱β-内酰胺酶（ESBLs）的菌株;测定MIC值;PCR扩增检测ampC基因及序列测定。 结果 15株菌中8株菌（53.3%）产AmpC酶，3株菌（20.0%）产ESBLs。产AmpC酶的菌株除对亚胺培南全敏感外，对其它抗菌药不同程度耐药。ampC基因与阴沟肠杆菌ECLC074的ampC基因高度同源。 结论 产AmpC酶是阴沟肠杆菌对β-内酰胺类抗生素耐药的主要机制之一。阴沟肠杆菌ECLC074ampC基因是我院主要的阴沟肠杆菌ampC基因型。产AmpC酶的阴沟肠杆菌常呈多重耐药，亚胺培南是治疗此类菌所致感染的最有效药物。 【关键词】 阴沟肠杆菌 头孢菌素酶 ampC基因 　　A variety ofβ-lactamases have been classified into classes A，B，C，and D according to their amino acid homologies［1］ .AmpCβ-lactamases，mostly conferring resistance to manyβ-lactam antibiotics（cephamycins and broad-spectrum cephalosporins），are included in class Cβ-lactamases.Chromosomally encoded AmpCβ-lacta-mases are present in Enterobacter spp.，Shigella spp.，Serratia marcescens，Citrobacter freundii，Morganella morganii，Providencia spp.，Pseudomonas aeruginosa，and Escherichia coli［2］ .Enterobacter cloacae are becom-ing increasingly important as nosocomial pathogens［3］ .In view of the spreading risk of AmpC resistance deter-minants among enterobacterial isolates，it is necessary to elucidate the AmpC resistance mechanism.This study was conducted to determine the prevalence and genotypes of AmpCβ-lactamases among clinical isolates of Enterobacter cloacae.Materials and methods Clinical strains15randomly chosen piperacillin-resistant E.cloacae were isolated from February2003to January2004in the Affiliated Hospital of North Sichuan Medical College. Detecting for production of ESBLs and AmpCβ-lactamases:Crudeβ-lactamase preparations were obtained by sonication and the qualitation detection ofβ-lactamase was performed by nitrocefin.The production of ESBLs was tested according to NCCLS Screening and Confirmatory test.AmpCβ-lactamase was examined by three dimension test ［4］ . Antibacterial susceptibility:MICs of antibacterials to AmpCβ-lactamase producers were determined by two-fold agar dilution method.E.coli ATCC25922and K.pneumoniae ATCC700603were used as reference st