肺炎克雷伯菌对β—内酰胺类抗生素耐药性主决定因素的研究

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[摘要] 目的 了解肺炎克雷伯菌对β—内酰胺类抗生素耐药性及耐药性特点，并探究其主决定因素。 方法 对临床送检的痰液、咽拭子、气管分泌物等做细菌培养，根据药敏试验结果分为敏感菌株、泛耐药菌株、多重耐药菌株3种菌株。分析菌株β—内酰胺酶活性以及细胞外膜通透性的变化。 结果 与敏感菌株组β—内酰胺酶活性（12±6） U/mg比较，泛耐药菌株组β—内酰胺酶活性（253±36） U/mg，多重耐药菌株组β—内酰胺酶活性均明显增多，差异显著，有统计学意义（P < 0.05）。而泛耐药菌株组β—内酰胺酶活性表达最高；与敏感菌株组细胞外膜通透性比较，泛耐药菌株组细胞外膜通透性、多重耐药菌株组细胞外膜通透性具有明显的阻碍作用，差异显著，有统计学意义（P

[关键词] 肺炎克雷伯菌；β—内酰胺类抗生素；决定因素

[中图分类号] R446.5 [文献标识码] B [文章编号] 1673—9701（2012）27—0138—02

Klebsiella pneumoniae to β—lactam antibiotic drug resistance lord of the determinants of research

ZHOU Qisheng LIU Yutian HUANG Miaojuan LIU Cihua

Internal Medicine， Pengpai Memorial Hospital of Haifeng County in Guangdong Province， Haifeng 516400， China

[Objective] Abstract About Klebsiella pneumoniae to β—lactam antibiotic resistance and resistance characteristics， and explore the deciding factor. Methods Strains of clinical sputum， throat swabs， tracheal secretion do the bacteria cultures， according to drug sensitivity test results are divided into： Sensitive strain group， Pan resistant strains group， Multiple drug—resistant strains of the three groups. Analysis strains β—lactamase activity and a cell's outer membrane permeability changes. Results The results and sensitive strain group β—lactamase activity（12±6） U/mg comparison， Pan resistant strains group β—lactamase activity （253±36） U/mg， Multiple drug—resistant strains group β—lactamase activity were significantly increased， Significant difference， with a statistical significance（P < 0.05）. And the Pan resistant strains group β—lactamase activity expression is the highest. And sensitive strain group a cell's outer membrane permeability comparison， Pan resistant strains group β—lactamase activity， multiple drug—resistant strains group a cell's outer membrane permeability has obvious side effect， Significant difference， with a statistical significance（P < 0.05）. And pan resistant strains group cell's outer membrane permeability obstruct the strongest. Conclusion β—lactamase activity and a cell's outer membrane permeability is K lebsiella pneumoniae to β—lactam antibiotic drug resistance the deciding factors.

[Key words] Klebsiella pneumoniae； β—lactam antibiotic； Decision factors

造成院内患者囊性纤维化、伤口感染及呼吸道感染患者肺炎流行的条件致病菌[1]主要是肺炎克雷伯菌。肺炎克雷伯菌感染的发生率几年来保持较高水平，而且随着抗生素的广泛应用，肺炎克雷伯菌对较广范围的抗生素产生了固有耐药性及多重耐药性[2]，所以有必要探讨肺炎克雷伯菌耐药的机制，以寻找更有效的抗生素。我们对几类肺炎克雷伯菌进行耐药机制分析，评价不同耐药因素影响，现报道如下。