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目的了解致细菌性肝脓肿的肺炎克雷伯杆菌多位点序列分型及药敏情况。方法收集2011年1月至2012年6月在浙江大学医学院附属第一医院感染科住院的细菌性肝脓肿患者,脓液培养为肺炎克雷伯杆菌的23株菌株,对23株菌株进行多位点序列分型;应用K-B纸片扩散法检测23株肺炎克雷伯杆菌菌株对10种抗菌药物的敏感性;应用超广谱β-内酰胺酶(ESBLs)确认试验了解23株菌株的产ESBLs情况。结果 23株菌株经过多位点序列分型:ST23为最主要序列型,共有10株,ST25、ST30、ST65、ST86、ST163、ST367、ST375、ST380、ST660、ST700及ST806各1株,2株为新的ST型,未发现文献报道的产耐碳氢酶烯酶的常见ST型;23株菌株的药敏结果对哌拉西林他唑巴坦及头孢哌酮舒巴坦等8种抗菌药物的耐药率为0%,对头孢呋辛耐药率4.4%,而对氨苄西林的耐药率为100%;ESBLs确认试验其中22株为ESBL-;1株为ESBL+。结论收治的致细菌性肝脓肿的肺炎克雷伯杆菌均为敏感菌株,可以经验性的选用青霉素(三代头孢)复合制剂,避免碳氢酶烯类抗生素的乱用及滥用。
Objective To understand the multi-locus typing and drug susceptibility of Klebsiella pneumoniae causing bacterial liver abscess. Methods From January 2011 to June 2012, 23 patients with bacterial liver abscess were admitted to Department of Infectious Diseases, the First Affiliated Hospital of Medical School of Zhejiang University, and 23 strains of Klebsiella pneumoniae were cultured in pus 23 strains of Klebsiella pneumoniae strains were tested for their susceptibility to 10 antibacterials using the KB disk diffusion method. The results of ESBLs confirming tests of 23 strains ESBLs situation. Results Twenty-three isolates were sequenced by multiple loci: ST23 was the most predominant type, with 10 strains of ST25, ST30, ST65, ST86, ST163, ST367, ST375, ST380, ST660, ST700 and ST806, For the new ST type, no common ST-type was reported in the literature. The susceptibility results of 23 isolates to 8 antibacterials such as piperacillin and tacrolimus and sulbactam The resistance rate to cefuroxime was 4.4%, but the resistance rate to ampicillin was 100%. ESBLs confirmed that 22 of them were ESBL- and 1 was ESBL +. Conclusions The Klebsiella pneumoniae that caused by bacterial liver abscess were all sensitive strains. The penicillin (third generation cephalosporin) compound could be used empirically to avoid the misuse and abuse of the hydrocephalic antibiotics.