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伊朗德黑兰 Labbafinejad 医院临床分离肺炎克雷伯菌中 bla(TEM)、bla(SHV)、bla(CTX-M) 基因的分布。

Distribution of bla(TEM), bla(SHV), bla(CTX-M) genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran.

机构信息

Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Poosrsina St. Tehran 1417613151, Iran.

出版信息

Microb Drug Resist. 2010 Mar;16(1):49-53. doi: 10.1089/mdr.2009.0096.

Abstract

Extended-spectrum beta-lactamase (ESBL)-producing isolates of Klebsiella pneumoniae have been increasingly recognized in the hospital settings in Iran as well as throughout the world. The aim of this study was to detect and determine the genes encoding the ESBLs including bla(TEM), bla(SHV), and bla(CTX-M) groups among the K. pneumoniae isolates at Labbafinejad Hospital by polymerase chain reaction (PCR) and characterize them by direct sequencing of PCR products. Eighty-nine isolates were isolated from patients at different wards during March 2008-March 2009. They were identified as K. pneumoniae using biochemical tests. Susceptibility of isolates to 17 different antimicrobial agents was determined using agar disk diffusion method. The phenotypic confirmatory test was used to screen the isolates for production of ESBLs. To amplify the bla(SHV) the template DNA was extracted by boiling method. Plasmid DNA was extracted using minipreparation kit and used as template in PCR for detection of bla(TEM) and bla(CTX-M). The selected PCR products were sequenced and analyzed. All 89 strains were susceptible to imipenem. The rates of resistance to different antibiotics were in the following order: aztronam (79.7%), cefexime (67.4%), cefpodoxime (66.2%), cefotaxime (65.1%), ceftazidime (61.7%). The phenotypic confirmatory test detected 62 isolates (69.7%) as ESBL-producing K. pneumoniae. The prevalence of genes encoding ESBLs were as follows: bla(TEM) 54% (n = 48), bla(SHV) 67.4% (n = 60), bla(CTX-M-I) 46.51% (n = 40), and bla(CTX-M-III) 29% (n = 25). The bla(CTX-M-II) and bla(CTX-M-IV) were not detected. All bla(TEM) types were characterized as bla(TEM-1) and all bla(CTX-M-I) were identified as bla(CTX-M-15). The SHV types were characterized as SHV-5, SHV-11, and SHV-12. The rate of ESBL at Labbafinejad Hospital was 25% increase in a 4-year study that ended in March 2009. It appears that bla(TEM-1), bla(SHV-5), bla(SHV-11), bla(SHV-12), and bla(CTX-M-15) are the dominant ESBLs among the resistant strains of K. pneumoniae in Iran.

摘要

产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌分离株在伊朗乃至世界各地的医院环境中越来越受到关注。本研究的目的是通过聚合酶链反应(PCR)检测和确定肺炎克雷伯菌分离株中编码 ESBL 的基因,包括 bla(TEM)、bla(SHV)和 bla(CTX-M)组,并通过 PCR 产物的直接测序对其进行表征。

2008 年 3 月至 2009 年 3 月期间,从不同病房的患者中分离出 89 株分离株。它们通过生化试验被鉴定为肺炎克雷伯菌。使用琼脂扩散法测定分离物对 17 种不同抗菌药物的敏感性。使用表型确证试验筛选产 ESBL 的分离物。

为了扩增 bla(SHV),通过煮沸法提取模板 DNA。使用 minipreparation 试剂盒提取质粒 DNA,并将其用作 PCR 检测 bla(TEM)和 bla(CTX-M)的模板。对选定的 PCR 产物进行测序和分析。所有 89 株均对亚胺培南敏感。对不同抗生素的耐药率依次为:aztronam(79.7%)、头孢克肟(67.4%)、头孢泊肟(66.2%)、头孢噻肟(65.1%)、头孢他啶(61.7%)。表型确证试验检测到 62 株(69.7%)产 ESBL 的肺炎克雷伯菌。

编码 ESBL 的基因的流行率如下:bla(TEM)54%(n=48)、bla(SHV)67.4%(n=60)、bla(CTX-M-I)46.51%(n=40)和 bla(CTX-M-III)29%(n=25)。未检测到 bla(CTX-M-II)和 bla(CTX-M-IV)。所有 bla(TEM)型均被鉴定为 bla(TEM-1),所有 bla(CTX-M-I)均被鉴定为 bla(CTX-M-15)。SHV 型被鉴定为 SHV-5、SHV-11 和 SHV-12。在 2008 年 3 月至 2009 年 3 月结束的为期 4 年的研究中,拉巴菲纳德医院的 ESBL 率增加了 25%。

似乎 bla(TEM-1)、bla(SHV-5)、bla(SHV-11)、bla(SHV-12)和 bla(CTX-M-15)是伊朗产超广谱β-内酰胺酶肺炎克雷伯菌耐药株中的主要 ESBL。

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