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目的检测本院NICU患儿中分离的肺炎克雷伯菌(KP)的耐药谱、耐药基因及同源性,探讨本次院感暴发流行的原因。方法收集2015年10月3日-10月29日本院NICU患者标本中分离的ESBL阳性KP菌株,共12株,环境采样获得2株;用VITEK 2-Compact全自动微生物分析系统进行菌株的鉴定和药敏试验,用PCR技术扩增常见的超广谱β-内酰胺酶(ESBLs)基因和碳青霉烯酶基因;用脉冲场凝胶电泳(PFGE)分析菌株的同源性。结果分离自患者的12株和来源于环境的2株KP均产ESBLs,除对头孢替坦、舒普深、碳青霉烯类、丁胺卡那和左旋氧氟沙星较敏感外,对头孢菌素类表现出较高的耐药性;菌株主要携带SHV、TEM、CTX-M-1、CTX-M-9 4种ESBLs基因,检出率分别为100%、85.7%、28.6%和14.3%。PFGE分型可将菌株分为A、B、C 3个克隆型。结论 NICU存在产ESBLs酶KP的克隆传播,多携带2种或以上的耐药基因。头孢替坦、舒普深和碳青霉烯类的药物可作为治疗产ESBLs酶KP感染经验性用药的首选。
Objective To detect the drug resistance spectrum, drug resistance gene and homology of Klebsiella pneumoniae (KP) isolated from children with NICU in our hospital and explore the reasons for the outbreak of nosocomial infection. Methods A total of 12 strains of ESBL-positive KP isolates from NICU patients in our hospital from October 3 to October 29, 2015 were collected, and 2 strains were obtained by environmental sampling. The strains were identified by VITEK 2-Compact automatic microbiological analysis system The susceptibility test was carried out. Common ESBLs and carbapenemase genes were amplified by PCR. The homology of strains was analyzed by pulsed-field gel electrophoresis (PFGE). Results ESBLs were produced in 12 isolates from patients and 2 KP derived from the environment, except for cefotetan, shuxunshen, carbapenems, amikacin and levofloxacin, Cephalosporins showed high drug resistance. The strains mainly contained four ESBLs genes, SHV, TEM, CTX-M-1 and CTX-M-9. The detection rates were 100%, 85.7% and 28.6% 14.3%. PFGE typing strains can be divided into A, B, C three clonotypes. Conclusion NICU has ESBLs-producing KP clones that carry two or more resistant genes. Cefotetan, Shu Pushen and carbapenem drugs can be used as the treatment of ESBLs enzyme KP infection empirical choice of the first choice.