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目的检测质粒AmpC酶的基因型及耐药特性,指导临床合理使用抗菌药物,减少耐药菌株的流行及传播。方法选择华中科技大学同济医学院附属同济医院细菌室2004年1-12月,非重复分离肺炎克雷伯菌218株,改良三维试验筛选产AmpC酶菌株,多重PCR和基因测序检测质粒AmpC酶基因型别,琼脂稀释法检测其对15种抗菌药物的最低抑菌浓度。结果改良三维试验检出13株AmpC酶,检出率为5.96%,经多重PCR测定,7株菌约在405 bp出现阳性条带,经基因测序证实为DHA-1型质粒AmpC酶,检出率为3.2%;7株质粒AmpC酶肺炎克雷伯菌对头孢西丁、头孢唑林、头孢呋辛及酶抑制剂联合制剂阿莫西林/克拉维酸全部耐药,对其他头孢类、单环β-内酰胺酶类、含酶抑制剂药物、氨基糖苷类及氟喹诺酮类药物普遍耐药,只有亚胺培南对其显示较好抗菌活性,尚未见耐药菌株出现。结论同济医院肺炎克雷伯菌中检出DHA-1型质粒AmpC酶,检出率为3.2%,产酶株显示多重耐药特性。
Objective To detect the genotype and drug resistance characteristics of plasmid AmpC enzyme, to guide the rational use of antimicrobial agents in clinic and to reduce the spread and spread of drug resistant strains. Methods The bacteria room of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology was selected from January to December in 2004. 218 strains of Klebsiella pneumoniae were isolated and non-repetitive. AmpC enzyme was screened by improved three-dimensional test. The AmpC gene was detected by multiplex PCR and gene sequencing Type, agar dilution method to detect the minimum inhibitory concentration of 15 kinds of antibacterial drugs. Results In the improved three-dimensional test, 13 AmpCases were detected with a detection rate of 5.96%. After multiple PCR, the positive bands of about 405 bp appeared in 7 strains. The positive clones were identified as DHA-1 plasmid AmpC enzyme by gene sequencing. The rate of 3.2%; 7 strains of PlasmcA pneumonia Klebsiella on cefoxitin, cefazolin, cefuroxime and enzyme inhibitor combination of amoxicillin / clavulanic acid resistance to other cephalosporins, single Central β-lactamases, enzyme inhibitor-containing drugs, aminoglycosides and fluoroquinolones are generally resistant, and only imipenem shows good antibacterial activity against them. No drug-resistant strains have yet been found. Conclusions The DHA-1 plasmid AmpC enzyme was detected in Klebsiella pneumoniae in Tongji Hospital. The detection rate was 3.2%. The enzyme-producing strains showed multi-drug resistance.