一家三级护理医院中产超广谱β-内酰胺酶肺炎克雷伯菌的患病率

Prevalence of extended spectrum -lactamase producing Klebsiella pneumoniae in a tertiary care hospital.

作者信息

Shukla I, Tiwari R, Agrawal M

机构信息

Department of Microbiology, JN Medical College, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh, India.

出版信息

Indian J Med Microbiol. 2004 Apr-Jun;22(2):87-91.

PMID:17642702

Abstract

PURPOSE

The purpose of this study was to know prevalence of extended spectrum -lactamase (ESBL) in multi drug resistant (MDR) strains of Klebsiella pneumoniae isolated from different clinical samples.

METHODS

A total of 120 MDR strain of K. pneumoniae were selected for the study, 106 of which were resistant to at least one of the third generation cephalosporins (3GC). They were studied for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) and by double disc synergy test (DDST).

RESULTS

88.3% (106) of the isolates were found to be resistant to at least one of the 3GC tested (cefotaxime, ceftazidime and ceftriaxone) and 72% of the isolates were resistant to all the 3GC tested. ESBL was detected in 30.18% (32) of the K. pneumoniae by PCDDT and in 27.3% (29) by DDST. Among the ESBL producers 6 (18.75%) were sensitive to cefotaxime, 2 (6.25%) to ceftazidime and 3 (9.37%) to ceftriaxone by disc diffusion test. The minimum inhibitory concentrations (MICs) of 3GC for these strains ranged from 2-8 microg/mL while for non ESBL producer sensitive counterparts it ranged from 0.03-1 microg/mL. Resistance to cefotaxime was transferred to recipient E. coli K12 strains J62-1. All the K. pneumoniae isolates were sensitive to imipenem. Resistance against amoxicillin, gentamicin, ciprofloxacin and amikacin was found in 93.28, 70, 10.37 and 26.14% of the isolates respectively.

CONCLUSIONS

Our study shows presence of ESBL producer K. pneumoniae in clinical isolates. The routine antimicrobial sensitivity test may fail to detect ESBL mediated resistance against 3GC and detection of ESBL production should be carried out as a routine in diagnostic laboratories by PCDDT as it is a simple and cost effective test.

摘要

目的

本研究旨在了解从不同临床样本中分离出的多重耐药肺炎克雷伯菌中广谱β-内酰胺酶（ESBL）的流行情况。

方法

共选择120株多重耐药肺炎克雷伯菌进行研究，其中106株对至少一种第三代头孢菌素（3GC）耐药。通过表型确证纸片扩散试验（PCDDT）和双纸片协同试验（DDST）对它们进行ESBL产生情况的研究。

结果

88.3%（106株）的分离株对至少一种所检测的3GC（头孢噻肟、头孢他啶和头孢曲松）耐药，72%的分离株对所有所检测的3GC耐药。通过PCDDT在30.18%（32株）的肺炎克雷伯菌中检测到ESBL，通过DDST在27.3%（29株）中检测到ESBL。在ESBL产生菌中，通过纸片扩散试验，6株（18.75%）对头孢噻肟敏感，2株（6.25%）对头孢他啶敏感，3株（9.37%）对头孢曲松敏感。这些菌株对3GC的最低抑菌浓度（MIC）范围为2 - 8μg/mL，而对非ESBL产生菌的敏感对应菌株，其MIC范围为0.03 - 1μg/mL。对头孢噻肟的耐药性转移至受体大肠杆菌K12菌株J62 - 1。所有肺炎克雷伯菌分离株对亚胺培南敏感。分别在93.28%、70%、10.37%和26.14%的分离株中发现对阿莫西林、庆大霉素、环丙沙星和阿米卡星耐药。