Ko Chi Seon, Sung Ji Yun, Koo Sun Hoe, Kwon Gye Cheol, Shin So Yeon, Park Jong Woo
Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea.
Korean J Lab Med. 2007 Oct;27(5):344-50. doi: 10.3343/kjlm.2007.27.5.344.
Extended-spectrum beta-lactamases (ESBLs) are cephalosporinases that confer resistance to a wide variety of oxyimino cephalosporins and create serious therapeutic problems. Although ESBLs have been reported with increasing frequency in Korea, their prevalence and genotypic distribution in Daejeon remain unknown. This study was designed to evaluate the occurrence and genotypic distributions of ESBL-producing Escherichia coli and Klebsiella pneumoniae in Daejeon.
We tested a total of 427 isolates of E. coli and K. pneumoniae at Chungnam National University Hospital during the period from March to September 2006. ESBL production was determined by the Clinical and Laboratory Standards Institute ESBL confirmatory test; minimum inhibitory concentrations of beta-lactam antibiotics were determined by the broth dilution method. The ceftazidime or cefotaxime resistance of the ESBL-producers was transferred to azide-resistant E. coli J53 by conjugation. Searches for ESBL genes were performed by PCR amplification, and the genotypes of ESBLs were determined by direct nucleotide sequence analysis of the amplified products. The pIs of ESBL were determined by isoelectric focusing.
The proportion of ESBL-producers was 10% of the E. coli and 28% of the K. pneumoniae isolates. The prevalence of ESBL-positive isolates was 60% in the intensive care units and 18.7% in the general wards. The most prevalent ESBL genotype in E. coli isolates was bla(CTX-M) and in K. pneumoniae was bla(SHV-12).
E. coli and K. pneumoniae isolates producing SHV-12 or CTX-M-type ESBLs are widespread in Daejeon.
超广谱β-内酰胺酶(ESBLs)是头孢菌素酶,可使细菌对多种氧亚氨基头孢菌素产生耐药性,从而引发严重的治疗问题。尽管在韩国,ESBLs的报道日益增多,但大田地区其流行情况和基因型分布仍不清楚。本研究旨在评估大田地区产ESBL的大肠埃希菌和肺炎克雷伯菌的发生情况及基因型分布。
2006年3月至9月期间,我们在忠南国立大学医院共检测了427株大肠埃希菌和肺炎克雷伯菌。通过临床和实验室标准协会的ESBL确证试验确定ESBL的产生;采用肉汤稀释法测定β-内酰胺类抗生素的最低抑菌浓度。通过接合试验将产ESBL菌株对头孢他啶或头孢噻肟的耐药性转移至叠氮化物耐药的大肠埃希菌J53。通过PCR扩增寻找ESBL基因,并通过对扩增产物进行直接核苷酸序列分析确定ESBL的基因型。通过等电聚焦法测定ESBL的等电点。
产ESBL菌株在大肠埃希菌分离株中占10%,在肺炎克雷伯菌分离株中占28%。ESBL阳性分离株在重症监护病房的患病率为60%,在普通病房为18.7%。大肠埃希菌分离株中最常见的ESBL基因型是bla(CTX-M),肺炎克雷伯菌中是bla(SHV-12)。
产SHV-12或CTX-M型ESBL的大肠埃希菌和肺炎克雷伯菌分离株在大田地区广泛存在。