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分析

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。

MLST of Klebsiella pneumoniae causing bacterial liver abscess and the drug sensitivity

Objective To learn the MLST of Klebsiella pneumoniae causing bacterial liver abscess and the drug sensitivity. Methods Pus specimens collected from inpatients with bacterial liver abscess from January 2011 to June 2012 were cultured, resulting in 23 strains of Klebsiella pneumoniae on which muhilocus sequence typing was performed. Their susceptibilities to 10 antimicrobial agents were detected by using Kirby-Bauer disk diffusion method, and extended-spectrumβ-1actamase test was conducted to detect their ESBL production. Results The predominant type was ST 23 （10 strains）. Other types included ST25, ST30, ST65, ST86, ST163, ST367, ST375, ST380, ST660, ST700, ST806 （ one strain each） and two new ST types. No carbepenem resistant Klebsiella pneumoniae of common ST type was found. All the strains were sensitive to the third generation cephalosporins. Twenty-two were ESBLs negative and one positive. Conclusion The Klebsiella pneumoniae causing bacterial liver abscess isolated in my division are all sensitive strains. We can use penicillin （the third generation cephalosporins） with enzyme inhibitor, and avoid drug abuse