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| 157株剖宫产术后感染肺炎克雷伯菌产ESBLs和AmpC酶及耐药性分析 |
| Analysis of ESBLs and AmpC Enzyme Production and Drug Resistance of 157 Strains of Klebsiella pneumoniae Infected after Cesarean Section |
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| DOI： |
| 中文关键词: 肺炎克雷伯菌 超广谱β内酰胺酶 头孢菌素酶 耐药性 |
| 英文关键词:Klebsiella pneumoniae Extended spectrum β lactamases AmpC enzymes Drug resistance |
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| 中文摘要: |
| 摘 要 目的：探讨我院产妇剖宫产术后切口感染的肺炎克雷伯菌产超广谱β内酰胺酶（ESBLs）和头孢菌素酶（AmpC酶）情况及其耐药性，为临床合理使用抗菌药物提供依据。 方法：收集2017年1～12月产妇剖宫产术后切口感染的分泌物标本分离的肺炎克雷伯菌157株； 菌株鉴定采用VITEK 2 Compact 全自动微生物分析仪进行鉴定；产ESBLs检测按CLSI推荐的确证试验；产AmpC酶初筛试验采用头孢西丁纸片扩散法，确证试验采用三维试验；药敏试验采用K B纸片扩散法。 结果：在肺炎克雷伯菌157株中，检出产ESBLs和AmpC酶菌株共82株（52.23%），其中单产ESBLs 36株＞同产ESBLs和AmpC酶25株＞单产AmpC酶21株。产酶株耐药率明显高于非产酶株，耐药现象在同产ESBLs和AmpC酶菌株中更为严重。单产和同产ESBLs和AmpC酶的菌株对头孢吡肟普遍具有较高敏感性，单产酶菌株除此还对哌拉西林/他唑巴坦和阿米卡星有较高的敏感性。 结论：台州恩泽医疗中心（集团）恩泽医院产妇剖宫产术后切口感染检出的肺炎克雷伯菌单产、同产ESBLs和AmpC酶菌株检出率高于非产酶株，临床应合理应用抗菌药物以减少产酶菌株的产生和蔓延。 |
| 英文摘要: |
| ABSTRACT Objective:To explore the ESBLs and AmpC enzymes of Klebsiella pneumoniae infected with incision infection after cesarean section in parturient, and to provide experimental basis for rational use of antimicrobial agents in clinic. Methods:From January to December 2017, 157 strains of Klebsiella pneumoniae isolated from the secretions infected after cesarean section were collected. The strains were identified by VITEK 2 Compact automatic microbiological analyzer, and the ESBLs production test was confirmed according to the CLSI recommendation. The primary screening test for the production of AmpC enzyme was carried out by cefoxitin disk diffusion method, the confirmatory test by three dimensional test, and the drug sensitivity test by K B disk diffusion method. Results:Among 157 strains of Klebsiella pneumoniae, 82 strains (52.23%) producing ESBLs and AmpC enzyme were detected , 36 strains per unit of ESBLs > 25 strains of coproduction of ESBLs and AmpC enzyme > 21 strains of specific production of AmpC enzyme. The drug resistant rate of enzyme producing strains was significantly higher than that of non enzyme producing strains, and the drug resistance was more serious in co producing strains of ESBLs and AmpC. The strains producing and co producing ESBLs and AmpC enzymes were generally highly sensitive to cefepime. Moreover, the strains producing specific enzymes had good antibacterial activity against piperacillin / tazobactam and amikacin. Conclusion:The positive rates of Klebsiella pneumoniae per unit and co producing strains of ESBLs and AmpC were higher than those of non producing strains t after cesarean section in parturient in Taizhou Enze Medical Center(Group) Enze Hospital. And the clinical application of antimicrobial drugs should be reasonable to reduce the production and spread of enzyme producing strains. |
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