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目的探讨临床分离的肺炎克雷伯菌对氨基糖苷类、喹诺酮类药物的耐药及耐药基因携带情况。方法从近两年信阳市中心医院收治患者的标本中分离出肺炎克雷伯菌40株,采用VITEK-2型全自动细菌鉴定系统鉴定细菌;纸片琼脂扩散法检测细菌对氨基糖苷类及喹诺酮类药物的敏感性;并采用聚合酶链反应检测耐药基因aac(6)-Ib,qnr S、qnr A、qnr B。观察并比较细菌对两组药物的耐药情况以及耐药基因检测结果。结果 40株肺炎克雷伯菌中,对氨基糖苷类药物庆大霉素、妥布霉素、阿米卡星的耐药率分别为97.50%、52.50%、28.50%;耐药基因aac(6’)-Ⅰb的检出率为50.00%。肺炎克雷伯菌对喹诺酮类药物环丙沙星、加替沙星、左氧氟沙星的耐药率分别为90.00%、82.50%、92.50%;喹诺酮类耐药基因qnr S检出率为35.00%,qnr B基因检出率为17.50%,qnr A基因检出率为0.00%,(可加qnr基因总阳性率52.5%)。结论肺炎克雷伯菌的耐药基因中qnr基因较常见,而其对氨基糖苷类药物产生耐药的主要原因是携带aac(6’)-Ⅰb基因。
Objective To investigate the clinical isolates of Klebsiella pneumoniae on aminoglycosides, quinolones resistance and resistance gene carriers. Methods Forty isolates of Klebsiella pneumoniae were isolated from specimens of patients admitted to Xinyang Central Hospital in recent two years. Bacteria were identified by VITEK-2 automatic bacterial identification system. The agar diffusion test was used to detect the aminoglycosides and quinolones The sensitivity of the drug-resistant genes aac (6) -Ib, qnr S, qnr A, qnr B was detected by polymerase chain reaction. Observe and compare the bacterial resistance to both drugs and the results of drug resistance test. Results The resistance rates of aminoglycosides gentamicin, tobramycin and amikacin were 97.50%, 52.50% and 28.50% respectively in 40 strains of Klebsiella pneumoniae. The resistance gene aac (6 ’) -Ib detection rate of 50.00%. The resistance rates of Klebsiella pneumoniae to quinolones ciprofloxacin, gatifloxacin and levofloxacin were 90.00%, 82.50% and 92.50%, respectively. The detection rate of quinolone resistance gene qnr S was 35.00%, qnr The detection rate of B gene was 17.50%, the detection rate of qnr A gene was 0.00%, and the total positive rate of qnr gene was 52.5%. Conclusions The qnr gene of Klebsiella pneumoniae is more common, and the main reason of its resistance to aminoglycosides is carrying aac (6 ’) - Ⅰb gene.