临床医学论文-临床分离产AmpCβ┐内酰胺酶阴沟肠杆菌的耐药性分析

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1、临床医学论文•临床分离产AmpC^n内酰胺酶阴沟肠杆菌的耐药性分析作者：凌保东余娴谢勇恩雷军【摘要】目的研究我院临床分离阴沟肠杆菌的产AmpC酶耐药情况及ampC基因型。方法收集临床分离的耐药阴沟肠杆菌15株;检测产AmpC酶和超广谱内酰胺酶(ESBLs)的菌株;测定MIC值;PCR扩增检测ampC基因及序列测定。结果15株菌中8株菌(53.3%)产AmpC酶，3株菌(20.0%)产ESBLs。产AmpC酶的菌株除对亚胺培南全墩感外，对其它抗菌药不同程度耐药。ampC基因与阴沟肠杆菌ECLC074的ampC基因高度同源。结论产AmpC酶是

2、阴沟肠杆菌对B-内酰胺类抗生索耐药的主要机制之一。阴沟肠杆菌ECLC074ampC基凶是我院主耍的阴沟肠杆菌ampC基因型。产AmpC酶的阴沟肠杆菌常呈多重耐药，亚胺培南是治疗此类菌所致感染的最有效药物。【关键词】阴沟肠杆菌头砲菌索酶ampC基因Avarietyof3-lactamaseshavebeenclassifiedintoclassesA,B,C,andDaccordingtotheiraminoacidhomologies[1].AmpC3actamascs,mostlyconferringresistancetomanyPa

3、ctamantibiotics(cephamycinsandbroad-spectrumcephalosporins),areincludedinclassCB-lactamases.ChTomosomallyencodedAmpCP-lacta-masesarepresentinEnterobactersppShigellasppSerratiamarcescens,Citrobacterfreundii,Morgancllamorganii,ProvidcnciasppPseudomonasaeruginosa,andEscheric

4、hiacoli[2].Enterobactercloacaearebecom・ingincreasinglyimportantasnosocomialpathogens[3].InviewofthespreadingriskofAmpCresistancedeter-minantsamongenterobacterialisolates,itisnecessarytoelucidatetheAmpCresistancemechanism.Thisstudywasconductedtodeterminetheprevalenceandgen

5、otypesofAmpCPactamasesamongclinicalisolatesofEnterobactercloacae・MaterialsandmethodsClinicalstrainsl5randomlychosenpiperaci11in-resistantE.cloacaewereisolatedfromFebruary2003toJanuary2004intheAffiliatedHospitalofNorthSichuanMedicalCollege.DetectingforproductionofESBLsandA

6、mpC3-lactamases:Crude3■1adamasepreparationswereobtainedbysonicationandthequalitationdetectionofB・1actamasewasperformedbynitrocefin.TheproductionofESBLswastestedaccordingtoNCCLSScreeningandConfirmatorytest.AmpCP-lactamasewasexaminedbythreedimensiontest[4].Antibacterialsusc

7、eptibility:MICsofantibacterialstoAmpCP-lactamaseproducersweredeterminedbytwo-foldagardilutionmethod・E.coliATCC25922andK.pneumoniaeATCC700603wcreusedasreferencestrains.PCRofampCgenes,thegenomicDNAofAmpCB・1actamaseproducers,waspreparedwiththegenomicDNAminipreparationkit(San

8、gon,Shanghai,China)andusedasthetemplateDNAinPCRanalysis.ThePCRprimerswereAmpCF(5‘-GACTCGCTATTACG