She Danyang, Liu Youning
Department of Respiratory Diseases, Chinese PLA Genernal Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2002 Oct 10;82(19):1355-8.
To investigate the expression of AmpC beta-lactamases and ESBL among clinical isolates of E. cloacae and its impact on antibiotic susceptibility.
Antibiotic susceptibility was determined by standard agar dilution procedures. beta-lactamases of the isolates with decreased susceptibilities to ceftazidime, cefotaxime, ceftriaxon or aztreonam were investigated by three-dimensional extract tests, isoelectric focusing overlay technique, conjugation experiments and PCR.
Among 106 E. cloacae isolates, 16.0% produced only high-level AmpC beta-lactamases, 10.4% produced only ESBL, 13.2% produced both high-level AmpC beta-lactamases and ESBL. 18 isolates (17.0%) carried CTX-M-type ESBL and 7 isolates (6.6%) carried SHV-type ESBL. All carbapenems showed high activity against E. cloacae strains (MIC90 <or= 2 micro g/ml). More than 70% of the isolates producing only high-level AmpC beta-lactamases were susceptible to cefepime, amikacin, gentamicin or ciprofloxacin. More than 60% of the isolates producing only ESBL were susceptible to piperacillin/tazobactam, cefoperazone/sulbactam, ciprofloxacin or amikacin. The susceptible rates of the isolates producing both high-level AmpC beta-lactamases and ESBL to tested antimicrobial agents other than carbapenems were all lower than 25%.
CTX-M-type ESBL was prevalent among clinical isolates of E. cloacae. Resistance to expanded-spectrum cephalosporins in E. cloacae was mediated not only by AmpC beta-lactamases but also by ESBL. Expression of ESBL in high-level AmpC beta-lactamases producing strains resulted in a significant rise in resistance level.
研究阴沟肠杆菌临床分离株中AmpC β-内酰胺酶和超广谱β-内酰胺酶(ESBL)的表达情况及其对抗生素敏感性的影响。
采用标准琼脂稀释法测定抗生素敏感性。通过三维提取试验、等电聚焦覆盖技术、接合试验和聚合酶链反应(PCR)对头孢他啶、头孢噻肟、头孢曲松或氨曲南敏感性降低的分离株的β-内酰胺酶进行研究。
在106株阴沟肠杆菌分离株中,16.0%仅产生高水平AmpC β-内酰胺酶,10.4%仅产生ESBL,13.2%同时产生高水平AmpC β-内酰胺酶和ESBL。18株(17.0%)携带CTX-M型ESBL,7株(6.6%)携带SHV型ESBL。所有碳青霉烯类药物对阴沟肠杆菌菌株均显示出高活性(MIC90≤2μg/ml)。仅产生高水平AmpC β-内酰胺酶的分离株中,超过70%对头孢吡肟、阿米卡星、庆大霉素或环丙沙星敏感。仅产生ESBL的分离株中,超过60%对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、环丙沙星或阿米卡星敏感。同时产生高水平AmpC β-内酰胺酶和ESBL的分离株对除碳青霉烯类药物外的受试抗菌药物的敏感率均低于25%。
CTX-M型ESBL在阴沟肠杆菌临床分离株中普遍存在。阴沟肠杆菌对广谱头孢菌素的耐药性不仅由AmpC β-内酰胺酶介导,也由ESBL介导。在产生高水平AmpC β-内酰胺酶的菌株中ESBL的表达导致耐药水平显著升高。