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目的研究肝病患者医院感染肺炎克雷伯菌(KPN)所产各种β-内酰胺酶(β-lase)分布情况及其耐药性,为临床合理用药提供依据。方法采用多底物纸片法(协同法、拮抗法)、超广谱β-内酰胺酶(ESBLs)确认试验、AmpC酶检测法检测30株肝病患者医院感染KPN所产各种β-lase,采用琼脂扩散法分析其耐药性。结果30株KPN总β-lase检出率为100.0%,其中产青霉素酶24株(80.0%),产广谱酶3株(10.0%),产ESBLs 3株(10.0%),未检出AmpC酶、复合产酶、碳青酶烯酶;肝病患者医院感染KPN对5大类9种抗菌药物较敏感,对环丙沙星、亚胺培南敏感(100.0%),对阿米卡星、庆大霉素较敏感(均90.0%),对氨苄西林耐药率高(100.0%)。结论β-lase检出率高,以青霉素酶、ESBLs为主,未检出AmpC酶、产复合酶、碳青酶烯酶;肝病患者医院感染KPN耐药率不高。
Objective To study the distribution and drug resistance of β-lase in hospital-acquired Klebsiella pneumoniae (KPN) in patients with liver disease and provide the basis for clinical rational drug use. Methods The multi-substrate paper method (synergistic method and antagonistic method) and extended-spectrum β-lactamase (ESBLs) confirmation test were used to detect various β-lase produced by hospital-acquired KPN in 30 liver disease patients by AmpC enzyme assay. Agar diffusion method was used to analyze the drug resistance. Results The detection rate of total β-lase of 30 KPN strains was 100.0%. Among them, 24 strains (80.0%) of penicillinase and 3 strains (10.0%) were ESBLs producing strains, and 10.0% Enzymes, compound enzyme and carbapenemase were the most common antibacterial agents in liver disease patients. KPN was more sensitive to 9 kinds of antibacterials in 5 categories and was sensitive to ciprofloxacin and imipenem (100.0%), to amikacin, Gentamycin was more sensitive (both 90.0%), high resistance to ampicillin (100.0%). Conclusions The detection rate of β-lase is high. Penicillinase and ESBLs are the main pathogens. AmpC enzyme, compound enzyme and carbapenemase are not detected. The rate of hospital-acquired KPN in liver disease is not high.