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首页> 外文期刊>Journal of Clinical Microbiology >Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing, Fluoroquinolone-Resistant Isolates of Klebsiella pneumoniae in Taiwan
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Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing, Fluoroquinolone-Resistant Isolates of Klebsiella pneumoniae in Taiwan

机译：台湾产肺炎克雷伯菌的广谱β-内酰胺酶耐药氟喹诺酮分离株的分子流行病学

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Strains of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged worldwide. Concomitant ciprofloxacin resistance with ESBL production in K. pneumoniae isolates would severely restrict treatment options. Among 39 (18.5%) of 211 ESBL-KP isolates resistant to ciprofloxacin (MIC, ≥4 μg/ml), 37 (95%) were high level resistant (MIC, ≥16 μg/ml). These isolates were also cross resistant to the newer fluoroquinolones, including levofloxacin, gatifloxacin, gemifloxacin, and garenoxacin (BMS 284756). Sitafloxacin was most active against these ciprofloxacin-resistant ESBL-KP isolates with MICs for 67% of the isolates being ≤2 μg/ml. The molecular epidemiology of these multiresistant isolates was investigated by automated ribotyping and pulsed-field gel electrophoresis (PFGE). Ribotyping identified 18 different strains among the 39 ciprofloxacin-resistant ESBL-KP isolates. The majority (67%) of these isolates were contained in six ribogroups which were further confirmed by PFGE. The distribution of the six major strains of ciprofloxacin-resistant ESBL-KP within Taiwan included one (ribogroup 255.3-PFGE type E) with a nationwide distribution and several institution-specific strains. Interhospital cooperation appears necessary, with strict infection control practices coupled with restriction of fluoroquinolone and extended-spectrum β-lactam use to control both the major epidemic strain and the more diverse strains observed within individual institutions.
机译：产生大范围β-内酰胺酶的肺炎克雷伯菌（ESBL-KP）菌株已在世界范围内出现。环丙沙星耐药性与 K中的ESBL产生。肺炎分离株将严重限制治疗选择。在211株对环丙沙星（MIC，≥4μg/ ml）耐药的ESBL-KP分离株中，有39株（18.5％）具有高水平耐药性（MIC，≥16μg/ ml）（37％（95％））。这些分离物还对新型氟喹诺酮类药物具有交叉耐药性，包括左氧氟沙星，加替沙星，吉非沙星和加仑沙星（BMS 284756）。西他沙星对这些耐环丙沙星的ESBL-KP分离株最有活性，MIC为67％≤2μg/ ml。通过自动核糖分型和脉冲场凝胶电泳（PFGE）研究了这些多抗分离株的分子流行病学。核糖体分型在39种耐环丙沙星的ESBL-KP菌株中鉴定出18种不同的菌株。这些分离物的大部分（67％）包含在六个核糖基团中，PFGE进一步证实了这些核糖基团。在台湾，六种主要的耐环丙沙星的ESBL-KP菌株的分布包括在全国范围内分布的一株（ribogroup 255.3-PFGE E型）和几种特定于机构的菌株。医院间的合作似乎是必要的，需要严格的感染控制措施，同时要限制使用氟喹诺酮和广谱β-内酰胺来控制主要的流行病菌株和在各个机构中观察到的更多样化的菌株。

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