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1. 重庆医科大学附属儿童医院检验科
2. 重庆医科大学检验系
纸质出版日期:2007,
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[1]刘岚,郑玉强,赵昕,刘昌林,朱军,谢伟,景春梅.儿童临床产ESBLs菌基因型分布及其耐药特征的研究[J].重庆医科大学学报,2007(02):142-146.
LIU Lan, et al. Distribution of gene typing of clinical ESBLs-producing bacterium in children and its drug resistance[J]. Journal of Chongqing Medical University, 2007,(2):142-146.
目的:对本地区2002~2004年儿童临床分离的产超广谱-β内酰胺酶(Extended-Spectrum β-Lactamases
ESBLs)细菌的流行特点和基因型别进行分析
了解产ESBLs细菌的耐药基因的型别分布和耐药特征变化情况。方法:用microscan walka-way-4.0细菌鉴定仪对4022株革兰氏阴性菌鉴定到种并做药敏分析
K-B法确认产ESBLs菌株
并用PCR法扩增
筛选其中108株ESBLs阳性菌株进行初步基因分型。结果:产ESBLs菌1468株
大肠埃希氏菌和肺炎克雷伯菌的分别为52.5%和65.8%;总产酶率为58.0%;2002~2004年产酶率分别为:68.2%、56.9%、50.8%。PCR初步分型结果表明:108株ESBLs菌检测到TEM、SHV及CTX三种基因型;大肠埃希氏菌59株
主要为TEM型(56/59);肺炎克雷伯菌29株
主要为SHV型(28/29);阴沟肠杆菌13株
以TEM型为主(12/13);铜绿假单孢菌7株
以TEM型为主(6/7)。2002年以TEM型为主(75%)
2003年主要为TEM型(40%)和SHV型(57.1%)
2004年主要为TEM型(90.9%)
CTX为少见基因型(3.7%)。产ESBLs菌对青霉素类、氨曲南及头孢菌素类抗生素耐药率为56.2%~100%
具有多重耐药特点。结论:产ESBLs菌发生率在逐年下降
产ESBLs菌主要携带TEM和SHV型β-内酰胺酶基因
其中绝大部分产TEM型β-内酰胺酶;但耐药情况不容乐观;提示临床应加强细菌耐药性与基因型变化的了解
合理用药
减少耐药菌的产生
更好的控制院内感染。
Objective:To analyze the epidemic characteristics and gene type of the Extended-Spectrum β-Lactamases(ESBLs)-producing Gram-negative bacterium in Chong-qing area from 2002 to 2004
and investigate its distribution of gene typing and drug resistance.Methods:There were 4022 Gram-negative bacterium isolated in clinic from 2002 to 2004
and they were identified and done the drug sensitivity by the microscan walkaway-4.0.ESBLs-producing strains were detected by K-B method and amplified by PCR.The DNA of 108 chosen ESBLs-producing strains were genotyped by Tripure Isolation Reagent.Results:1468 ESBLs-producing strains were detected.The rates of Escherichia.coli and Klebsiella.pneumoniae were 52.5% and 65.8% respectively.The general positive rate of ESBLs-producing was 58.0%.And the rates in year 2002
2003 and 2004 were 68.2%
56.9% and 50.8% 2002 to 2004 respectively.The result of PCR showed that 3 types of gene typing
TEM
SHV and CTX were detected in 108 chosen ESBLs-producing strainsThe TEM type was the main type in E.coli(56/59)
E.asburiane(12/13)and P.aeruginosa(6/7)while the SHV type was the main type in K.pneumoniae(28/29).TEM type was the main type for year 2002(75%)
both TEM(40%)and SHV(57.1%)for 2003
and TEM for 2004(90.9%)with CTX as infrequent type(3.7%).The resistance rates of ESBLs-producing isolates against penicillins
aztreonam and the third generation cephalosporins were about 56.2%-100%
and almost multi-resistant.Conclusion:The incidence of ESBLs-producing isolates was decreasing by year
and ESBLs-Producing isolates mainly carried TEM and SHV types of β-Lactamases with the TEM one as the major.Their drug resistances were not so good.Those indicated that it is necessany to strengthen the understanding about bacterium resistance and gene type change
administer medicines reasonably to decrease the resistant ones and control the infection in hospital better.
ESBLs基因分型耐药性
ESBLsGene typeresistance
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