يزﺎﻣﺎﺘﮐﻻﺎﺘﺑﺖﻣوﺎﻘﻣيﺎﻫنژعﻮﯿﺷ SHV/CTX-M/TEM
يرارداﺖﻧﻮﻔﻋزاهﺪﺷاﺪﺟﯽﻠﮐﺎﯿﺷﺮﺷارد
ناﺮﻬﺗﺮﻬﺷرد
هﺪﯿﮑﭼ
فﺪﻫوﻪﻨﯿﻣز
:
هداﻮﻧﺎﺧيﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآﻪﺑﺖﻣوﺎﻘﻣﻞﻣﺎﻋﻦﯾﺮﺘﻤﻬﻣ،يزﺎﻣﺎﺘﮐﻻﺎﺘﺑيﺎﻫﻢﯾﺰﻧآ
يﺮﺘﮐﺎﺑنﺎﯿﻣردمﺎﺘﮐﻻﺎﺘﺑ نآزاﯽﺷﺎﻧيﺎﻫﺖﻧﻮﻔﻋنوﺰﻓازورﺶﯾاﺰﻓاﺪﻫﺎﺷهزوﺮﻣا .ﺪﺷﺎﺑﯽﻣﯽﻔﻨﻣمﺮﮔيﺎﻫ
هﺪﺷحﺮﻄﻣﺎﯿﻧدﺢﻄﺳردرﻮﻬﻇﻮﻧﯽﻧﺎﻣردﯽﺘﺷاﺪﻬﺑتﻼﮑﺸﻣزاﯽﮑﯾناﻮﻨﻋﻪﺑﺮﻣاﻦﯾاﻪﮐﻢﯿﺘﺴﻫنﺎﻬﺟردﺎﻫ ﻻﺎﺘﺑيﺎﻫﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآﻪﺑﺖﺒﺴﻧﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآﺖﯿﺳﺎﺴﺣيﻮﮕﻟاﯽﺳرﺮﺑﻖﯿﻘﺤﺗﻦﯾامﺎﺠﻧازافﺪﻫ .ﺪﻧا مﺎﺘﮐ
زﺎﻣﺎﺘﮐﻻﺎﺘﺑيﺎﻫنژدﻮﺟونﻮﻣاﺮﯿﭘﻖﯿﻘﺤﺗو
blaCTX-M
blaTEM ,
،
blaSHV
يراردايﺎﻫﻪﻧﻮﻤﻧرد
E.coli
.ﺪﺷﺎﺑﯽﻣ
ﯽﺳرﺮﺑشور
:
داﺪﻌﺗ
246
ﻪﻟوﺰﯾا
E.coli
ﯽﻃناﺮﻬﺗﺮﻬﺷرديراردايﺎﻫﻪﻧﻮﻤﻧزاهﺪﺷاﺪﺟ
لﺎﺳ
1388 -89
ﯽﺘﻧآﺖﺴﺗ،ﺎﻫﻪﻧﻮﻤﻧﺖﻣوﺎﻘﻣﻦﯿﯿﻌﺗياﺮﺑ .ﺖﻓﺮﮔراﺮﻗﯽﺳرﺮﺑدرﻮﻣ شورﺎﺑماﺮﮔﻮﯿﺑ
Disk
diffusion
،ﻢﯾﺪﯾزﺎﺘﻔﺳ،ﻢﯿﺴﮐﺎﺗﻮﻔﺳ :زاﺪﻧدﻮﺑترﺎﺒﻋﯽﺳرﺮﺑﺖﺤﺗيﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآﺖﻓﺮﮔترﻮﺻ
)ﻦﯿﺳﺎﺴﮐﻮﻠﻓوﺮﭙﯿﺳوﺪﯿﺳاﮏﯿﺴﮑﯾﺪﯿﻟﺎﻧ،ﻢﻨﭘﯽﻤﯾا
Mast
شورزا .(
combined disk test
مﺎﺠﻧاﺖﻬﺟ
) يﺎﻫدراﺪﻧﺎﺘﺳا ﺎﺑ ﺞﯾﺎﺘﻧ .ﺪﯾدﺮﮔ هدﺎﻔﺘﺳا يﺪﯿﺋﺎﺗ ﺖﺴﺗ
CLSI
(
Clinical and laboratory
standards institute
يﺎﻫﻪﻟوﺰﯾاﺖﯾﺎﻬﻧردوﻪﺴﯾﺎﻘﻣ
ESBL
شورﻂﺳﻮﺗ،ﺖﺒﺜﻣ
PCR
نژﺮﻈﻧزا
يﺎﻫ
blaSHV,bla CTX-M,bla TEM .ﺪﻨﺘﻓﺮﮔراﺮﻗﯽﺳرﺮﺑدرﻮﻣ
ﻪﺘﻓﺎﯾ ﺎﻫ
:
زا
246
ﯽﺳرﺮﺑدرﻮﻣﻪﻟوﺰﯾا
116 ) 1/ 47
وﻢﯾﺪﯾزﺎﺘﻔﺳ ﻪﺑموﺎﻘﻣ ﻪﻟوﺰﯾا (% 96
) 2/ 39 (%
ﻮﻔﺳ ﻪﺑ موﺎﻘﻣ ﻪﻟوﺰﯾا ﻦﯿﻨﭽﻤﻫ .ﺪﻧدﻮﺑ ﻢﯿﺴﮐﺎﺗ
109 ) 3/ 44
ﺪﻟﻮﻣ ﻪﻟوﺰﯾا (%
ESBL
ﺎﻫ نژ .ﺪﻧدﻮﺑ
TEM
blaSHV,blaCTX-M,bla
) ردﺐﯿﺗﺮﺗﻪﺑ
1/ 87 (% 95 ) 8/ 68 (% 75 )و
6/ 70 (% 77
يﺎﻫﻪﻟوﺰﯾا
ESBL
ﺖﻓﺎﯾ
) .ﺪﺷ
6/ 36 (% 40
ﻦﯾاﺮﺑهوﻼﻋ .ﺪﻧدﻮﺑ ﺮﻈﻧدرﻮﻣنژﻪﺳﺮﻫيوﺎﺣﻪﻧﻮﻤﻧ
) 3/ 62 (% 68 نژودﺪﺟاوﻪﻧﻮﻤﻧ
blaSHV
و
blaTEM ) ،
9/ 55 (% 61
نژودﺪﺟاوﻪﻧﻮﻤﻧ
blaTEM
و
blaCTX-M )و
5/ 49 (% 54
ﺪﺟاوﻪﻧﻮﻤﻧ
نژود
blaSHV, blaCTX-M
ﺪﻧدﻮﺑ
:يﺮﯿﮔﻪﺠﯿﺘﻧ ﺖﺴﺗﻖﯿﻗدمﺎﺠﻧا،مﻮﺳﻞﺴﻧيﺎﻫﻦﯾرﻮﭙﺴﻟﺎﻔﺳﻪﺑﺖﻣوﺎﻘﻣيﻻﺎﺑﺪﺻردﻪﺑﻪﺟﻮﺗﺎﺑ
ﮔرازاﯽﺷﺎﻧيﺎﻫﺖﻧﻮﻔﻋردﮏﯿﺗﻮﯿﺑﯽﺘﻧآﺰﯾﻮﺠﺗزاﻞﺒﻗماﺮﮔﻮﯿﺑﯽﺘﻧآيﺎﻫ هﺪﻨﻨﮐﺪﯿﻟﻮﺗيﺎﻫﻢﺴﯿﻧﺎ
ESBL
،
.ﺖﺳاﺮﯾﺬﭘﺎﻧبﺎﻨﺘﺟاتروﺮﺿﮏﯾ يﺪﯿﻠﮐيﺎﻫهژاو
:
،يرارداﺖﻧﻮﻔﻋ،ﯽﻠﮐﺎﯿﺷﺮﺷا،ﻒﯿﻄﻟاﻊﯿﺳوزﺎﻣﺎﺘﮐﻻﺎﺘﺑ
SHV,CTX-M,TEM
يدﺰﯾﺎﺴﻬﻣ
هوﺮﮔ،يژﻮﻟﻮﯿﺑوﺮﮑﯿﻣﺪﺷراﯽﺳﺎﻨﺷرﺎﮐيﻮﺠﺸﻧاد
.ﻦﺑﺎﮑﻨﺗﺪﺣاودازآهﺎﮕﺸﻧاد،يژﻮﻟﻮﯿﺑوﺮﮑﯿﻣ
ﯽﻤﻇﺎﻧﯽﻠﻋ
ﯽﻣﻼﺳادازآهﺎﮕﺸﻧاد،يژﻮﻟﻮﯿﺑهوﺮﮔ،رﺎﯾدﺎﺘﺳا
ﻦﺑﺎﮑﻨﺗﺪﺣاو
ﯽﺴﮔﺮﻧيﺮﯿﻣﺪﻋﺎﺳﺮﯿﻣ
ازآهﺎﮕﺸﻧاد،يژﻮﻟﻮﯿﺑهوﺮﮔ،رﺎﯾدﺎﺘﺳا ﯽﻣﻼﺳاد
ﻦﺑﺎﮑﻨﺗﺪﺣاو
داﮋﻧﯽﻤﺗﺎﺧﺎﺿرﺪﻤﺤﻣ
ﯽﻣﻼﺳادازآهﺎﮕﺸﻧاد،يژﻮﻟﻮﯿﺑهوﺮﮔ،رﺎﯾدﺎﺘﺳا
ﻦﺑﺎﮑﻨﺗﺪﺣاو
ﯽﻔﯾﺮﺷبﻮﺷآﺮﻬﺷ
،ﯽﮑﺷﺰﭘيژﻮﻟﻮﯿﺑﺪﺷراﯽﺳﺎﻨﺷرﺎﮐيﻮﺠﺸﻧاد
ﯽﮑﺷﺰﭘيژﻮﻟﻮﯿﺑهﺪﮑﺸﻧاد ،
ﻪﯿﮐﺮﺗ،ارﺎﮑﻧآهﺎﮕﺸﻧاد
ﯽﯾﺎﺑﺎﺑﺎﯾﺎﻣ ﯽﺋاﺮﺴﮑﭼﻮﮐ
ﻮﻟﻮﯿﺑوﺮﮑﯿﻣﺪﺷراﯽﺳﺎﻨﺷرﺎﮐيﻮﺠﺸﻧاد هوﺮﮔ،يژ
.ﻦﺑﺎﮑﻨﺗﺪﺣاودازآهﺎﮕﺸﻧاد،يژﻮﻟﻮﯿﺑوﺮﮑﯿﻣ
لﻮﺌﺴﻣهﺪﻨﺴﯾﻮﻧ
: ﯽﻤﻇﺎﻧﯽﻠﻋ
: ﻦﻔﻠﺗ
09126051565
ﮏﯿﻧوﺮﺘﮑﻟاﺖﺴﭘ
:
alinazemy@yahoo.com
سردآ
:
ﻦﯾﺰﻨﺑﭗﻤﭘﺐﻨﺟيرﻮﻬﻤﺟنﺎﺑﺎﯿﺧ،ﻦﺑﺎﮑﻨﺗ
كﻼﭘ 351
:ﻪﻟﺎﻘﻣلﻮﺻو 25
/ 12 / 89
:ﯽﯾﺎﻬﻧحﻼﺻا
5 / 2 / 90
:ﻪﻟﺎﻘﻣشﺮﯾﺬﭘ 5
/ 2 / 90
يزﺎﻣﺎﺘﮐﻻﺎﺘﺑﺖﻣوﺎﻘﻣيﺎﻫنژعﻮﯿﺷ
SHV/CTX-M/TEM
رد ...
ﻪﻣﺪﻘﻣ
ﯽﻣ ﻪﺘﻓﺮﮔرﺎﮐﻪﺑﺎﻫيﺮﺘﮐﺎﺑﻂﺳﻮﺗﯽﻔﻠﺘﺨﻣيﺎﻫ يﮋﺗاﺮﺘﺳا
ﻤﺑنﻮﺼﻣﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآرﺎﺑنﺎﯾزتاﺮﺛازاﺎﺗدﻮﺷ
زاﯽﮑﯾﺪﻨﻧﺎ
ﻪﯿﻠﻋﯽﻔﻨﻣمﺮﮔيﺎﻫ يﺮﺘﮐﺎﺑردﻪﮐ،ﺎﻫﻢﺴﯿﻧﺎﮑﻣ ﻦﯾاﻦﯾﺮﺘﻤﻬﻣ
ﻢﯾﺰﻧآﺪﯿﻟﻮﺗدﻮﺷﯽﻣﻪﺘﻓﺮﮔرﺎﮐﻪﺑمﺎﺘﮐﻻﺎﺘﺑيﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآ
يزﺎﻣﺎﺘﮐﻻﺎﺘﺑ يﺎﻫ
Beta-lactamase-enzymes ) ﺪﺷﺎﺑﯽﻣ
1 .(
ﮏﯿﺗﻮﯿﺑﯽﺘﻧآرديﺰﮐﺮﻣﻪﺘﺴﻫﺰﯿﻟورﺪﯿﻫﻖﯾﺮﻃزاﺎﻫﻢﯾﺰﻧآﻦﯾا
ﻓﺮﯿﻏ ﺚﻋﺎﺑمﺎﺘﮐﻻﺎﺘﺑيﺎﻫ
ﺶﯾاﺪﯿﭘ .ﺪﻧﻮﺷﯽﻣﺎﻫ نآنﺪﺷلﺎﻌ
ﻊﯿﺳو يﺎﻫ ﯽﯾرﻮﭙﺴﻟﺎﻔﺳ ﻞﯿﺒﻗ زا ﺪﯾﺪﺟ يﺎﻫ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ
يرﺎﻤﯿﺑنﺎﻣردردﺎﻫنآزاهدﺎﻔﺘﺳاجاوروﺎﻫمﺎﻧﻮﺋﺮﺗزا،ﻒﯿﻄﻟا
ﻢﯾﺰﻧآﻦﯾازايﺪﯾﺪﺟﻪﺘﺳدزوﺮﺑﻪﺑﺮﺠﻨﻣلﺎﯾﺮﺘﮐﺎﺑﯽﻧﻮﻔﻋيﺎﻫ
) ﺖﺳاهﺪﺷ ﻒﯿﻄﻟاﻊﯿﺳويزﺎﻣﺎﺘﮐﻻﺎﺘﺑ مﺎﻧ ﻪﺑﺎﻫ
2
ﻊﻗاو رد .(
زوﺮﺑ
ﺎﺘﺑ يا ﻪﻨﯿﻣآﺪﯿﺳا ﺲﻧﺎﮑﺳ رد يا ﻪﻄﻘﻧ يﺎﻫ نﻮﯿﺳﺎﺗﻮﻣ
ﻪﯿﻟوايﺎﻫزﺎﻣﺎﺘﮐﻻ
TEM(1),TEM(2)
ﺶﯾاﺪﯿﭘوقﺎﻘﺘﺷاﺚﻋﺎﺑ
)ﺖﺳاهﺪﯾدﺮﮔﺎﻫﻢﯾﺰﻧآﻦﯾا
3
و
4
ﻪﻘﺒﻃياﺮﺑﯽﻔﻠﺘﺨﻣيﺎﻫﻮﮕﻟا .(
ًﺎﺗﺪﻤﻋﻪﮐﺎﻫشور ﻦﯾازاﯽﮑﯾ.دراددﻮﺟوﺎﻫزﺎﻣﺎﺘﮐﻻﺎﺘﺑيﺪﻨﺑ
شﻮﺑ ﻪﻠﯿﺳو ﻪﺑ ،دﻮﺷ ﯽﻣ هدﺎﻔﺘﺳا نآ زا
)
Bush
(
ﺟ ،
ﯽﺑﻮﮐﺎ
)
jacoby
(
سوﺮﯾﺪﻣ و
)
Medevios
(
ﻪﮐ ﺖﺳا هﺪﺷ عاﺪﺑا ،
ﯽﮑﯾﺰﯿﻓتﺎﯿﺻﻮﺼﺧوﯽﮔﺪﻨﻨﮐﺖﻌﻧﺎﻤﻣ،اﺮﺘﺴﺑﻮﺳعﻮﻧسﺎﺳاﺮﺑ
ﻪﺑ؛ ﺎﻫزﺎﻣﺎﺘﮐﻻ ﺎﺘﺑ ﮏﯾوﺮﺘﮑﻟاوﺰﯾا ﻪﻄﻘﻧو ﯽﻟﻮﮑﻟﻮﻣ نزو ﺮﯿﻈﻧ
ﯽﻠﺻا سﻼﮐ رﺎﻬﭼ ﺎﯾهوﺮﮔ رﺎﻬﭼ
D,C,B,A
ﯽﻣ يﺪﻨﺑ ﻪﻘﺒﻃ
ﯿﻄﻟا ﻊﯿﺳو يﺎﻫ ﻢﯾﺰﻧآ ،يﺪﻨﺑ ﻪﻘﺒﻃﻦﯾا سﺎﺳاﺮﺑ ﺪﻧﻮﺷ
رد ﻒ
هوﺮﮔ
A
ﻪﺘﻓﺎﯾنﻮﯿﺳﺎﺗﻮﻣيﺎﻫﻢﯾﺰﻧآتﺎﻘﺘﺸﻣﻞﻣﺎﺷوﻪﺘﻓﺮﮔراﺮﻗ
SHV,TEM
)ﺪﻨﺷﺎﺑ ﯽﻣ
5
و
6
ﭗﯿﺗ يﺎﻫزﺎﻣﺎﺘﮐﻻﺎﺘﺑ.(
CTX-M
ﻪﺑ
ﻞﻣﺎﺣ يﺎﻫﺪﯿﻤﺳﻼﭘ ﻖﯾﺮﻃ زا هدﺮﺘﺴﮔ رﻮﻃ
ESBL
ﺪﻗﺎﻓ ﻪﮐ
TEM
و
SHV
ردرﺎﺑ ﻦﯿﻟواياﺮﺑ وﺪﯾدﺮﮔ ﺮﺸﺘﻨﻣ ﺪﻨﺷﺎﺑ ﯽﻣ
ﻪﻫدﺮﺧاوا
1980
)ﺪﺷشراﺰﮔﺎﭘورارد
7
و
8
ﺑﺖﻣوﺎﻘﻣ .(
يﺮﺘﮐﺎ
ودردﻒﯿﻄﻟاﻊﯿﺳومﺎﺘﮐﻻﺎﺘﺑيﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآﻪﺑﯽﻔﻨﻣمﺮﮔ
رﻮﻃ ﻪﺑﺖﻣوﺎﻘﻣﻦﯾا ﺖﻓﺎﯾ شﺮﺘﺴﮔﺖﻋﺮﺳﻪﺑﻪﺘﺷﺬﮔي ﻪﻫد
يوﺎﺣيﺎﻫﺪﯿﻤﺳﻼﭘﻪﺑهﺪﻤﻋ
ESBLs )دﻮﺷﯽﻣهدادﺖﺒﺴﻧ
9 .(
زاﺶﯿﺑدوﺪﺣزوﺮﻣاﻪﺑﺎﺗ
200
عﻮﻧ
ESBLs
هﺪﺷﻒﺸﮐﺎﯿﻧدرد
ﺎﺑوﺮﺘﻧا هداﻮﻧﺎﺧ رد ﺎﻫ نآ ﺮﺜﮐا ﻪﮐ
ﺪﻧا هﺪﺷ هﺪﯾد ﻪﺳﺎﯾﺮﺘﮐ
) 10 .(
نﺎﻣردرددﻮﺟﻮﻣيﺎﻫ ناﺮﺤﺑ زاﯽﮑﯾناﻮﻨﻋﻪﺑ ﻪﻠﺌﺴﻣﻦﯾا
رﺎﺸﺘﻧاولﺎﻘﺘﻧا .ﺖﺳاحﺮﻄﻣﺎﻫيﺮﺘﮐﺎﺑﻦﯾازاﯽﺷﺎﻧيﺎﻫﺖﻧﻮﻔﻋ
ﺪﻨﺘﺴﻫرﻮﮐﺬﻣيﺎﻫﻢﯾﺰﻧآﺪﯿﻟﻮﺗﻪﺑردﺎﻗﻪﮐيﺎﻫﻢﺴﯿﻧﺎﮔراﻊﯾﺮﺳ
رد ﻪﻃﻮﺑﺮﻣ ﯽﻧﺎﺘﺳرﺎﻤﯿﺑ يﺎﻫ ﺖﻧﻮﻔﻋ ناﺰﯿﻣ ﻦﺘﻓر ﻻﺎﺑ ﺚﻋﺎﺑ
ﺮﺳاﺮﺳ
)ﺖﺳاهﺪﺷ ﺎﯿﻧد
11
ﯽﯾﺎﻫ يﺮﺘﮐﺎﺑزا ﯽﮑﯾ ﯽﻠﮐﺎﯿﺷﺮﺷا .(
يﺎﻫﻢﯾﺰﻧآﺪﯿﻟﻮﺗﻪﺑردﺎﻗﻪﮐﺖﺳا
ESBL
يﺮﺘﮐﺎﺑﻦﯾا .ﺪﺷﺎﺑﯽﻣ
ﺖﻧﻮﻔﻋزايرﺎﯿﺴﺑﻞﻣﺎﻋو ﻪﺳﺎﯾﺮﺘﮐﺎﺑوﺮﺘﻧاهداﻮﻧﺎﺧﯽﻠﺻاﻮﻀﻋ
ﺖﯾﮋﻨﻨﻣ، ﺖﯾﺮﺘﻧاوﺮﺘﺳﺎﮔ،ﺲﯿﺴﭙﺳ ﻞﯿﺒﻗزاﯽﻧﺎﺘﺳرﺎﻤﯿﺑيﺎﻫ
ﺳاهﺪﺷﻪﺘﺧﺎﻨﺷيرارداﺖﻧﻮﻔﻋﺺﺧﻻﺎﺑويدازﻮﻧ
)ﺖ
12
اﺬﻟ .(
نژنﻮﻣاﺮﯿﭘ ﻖﯿﻘﺤﺗوﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآ ﺖﯿﺳﺎﺴﺣ يﻮﮕﻟاﯽﺳرﺮﺑ
يرادايﺎﻫﻪﻧﻮﻤﻧرديزﺎﻣﺎﺘﮐﻻﺎﺘﺑيﺎﻫ
E.coli
فاﺪﻫاناﻮﻨﻋﻪﺑ
.ﺖﺳاهﺪﺷظﺎﺤﻟﻖﯿﻘﺤﺗﻦﯾا
هرودﮏﯾرد
8
هﺎﻣﻦﻤﻬﺑزاﻪﻫﺎﻣ
1388
هﺎﻣرﻮﯾﺮﻬﺷﺎﺗ
1389
داﺪﻌﺗ
444
ـﺳرﺎﻤﯿﺑ) ناﺮـﻬﺗيﺎـﻫنﺎﺘـﺳرﺎﻤﯿﺑزايرارداﻪﻧﻮﻤﻧ
نﺎﺘ
هﺎﮕﺸﯾﺎﻣزاﻪﺑوﺪﺷيروآﻊﻤﺟ(ﯽﻠﻋﻮﺑ،ﺪﯿﻔﻣ،ﯽﻣاﺮﻬﺑ،ﺮﻐﺻاﯽﻠﻋ
هدادلﺎـﻘﺘﻧاﻦﺑﺎﮑﻨﺗﺪﺣاوﯽﻣﻼﺳادازاهﺎﮕﺸﻧادﯽﺳﺎﻨﺷبوﺮﮑﯿﻣ
ﻦﻠﯿﺘﻣﻦﯾزﻮﺋاﯽﺑﺎﺨﺘﻧاﺖﺸﮐﻂﯿﺤﻣيورﺮﺑﺎﻫﻪﻧﻮﻤﻧﺲﭙﺳ . ﺪﺷ
ﻮﻠﺑ
)
EMB
(
يﺎـﻣدردﺎـﻫﺖـﯿﻠﭘوﺪﺷهدادﺖﺸﮐ
c ◦
37 ﯽﺘﻧﺎـﺳ
تﺪﻣﻪﺑداﺮﮔ
24
زاﺪﺷﻪﺑﻮﮑﻧاﺖﻋﺎﺳ
يﺎـﻫﺖﺴﺗمﺎﺠﻧا ﻖﯾﺮﻃ
ﻞﯿﺒﻗزاﯽﯾﺎﯿﻤﯿﺷﻮﯿﺑ
MR,VP
،تاﺮﺘﯿﺳنﻮﻤﯿﺳ،
TSI
،
SIM ﺮـﺑ
،ﺎﻫﯽﻨﻠﮐيور
246
ﻪﻟوﺰﯾا
E.coli
يﺎﻫﯽﻨﻠﮐ .ﺪﯾدﺮﮔﯽﯾﺎﺳﺎﻨﺷ
ﺖﺒﺜﻣيﺎﻫﻪﻟوﺰﯾاطﻮﺑﺮﻣ
E.coli
ردار
◦
70 -
ﺲﺘﭙﯾﺮـﺗﻂﯿﺤﻣرد
ﺎﻫﻪﻟوﺰﯾاﻦﯾازايﺪﻌﺑﻞﺣاﺮﻣردﺎﺗهدﺮﮐيراﺪﻬﮕﻧثاﺮﺑيﻮﺳ
ﯿﻌﺗ .دﻮﺷهدﺎﻔﺘﺳا
شورﻪﺑﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآﺖﻣوﺎﻘﻣوﺖﯿﺳﺎﺴﺣﻦﯿ
نژﻮﯿﻔﯾدﮏﺴﯾد
)
kriby-Baur
(
)ﺪـﻨﺘﻓﺮﮔترﻮـﺻ
13 ﮏـﺴﯾد.(
درﻮـــــــﻣيﺎـــــــﻫ
ﻢﯿـــــــﺴﮐﺎﺗﻮﻔﺳ : ﻞﻣﺎـــــــﺷهدﺎﻔﺘـــــــﺳا
(
30
µ
g
)
ﻢﯾﺪﯾزﺎﺘﻔــــــــــــــــﺳ،
(
30µg)
ﯽــــــــــــــــﻤﯾا،
ﻢﻨـــــــﭘ
(
10
µ
g
)
ﺪﯿـــــــﺳاﮏﯿـــــــﺴﮑﯾﺪﯿﻟﺎﻧ،
(
30
µ
g
)
و
ﺴﮐﻮﻠﻓوﺮﯿﭙﺳ ﻦﯿﺳﺎ
(
5
µ
g
)
ﺖﮐﺮﺷزا
Mast
.ﺪﻧدﻮﺑ
هرود،ﯽﻫﺎﮕﺸﯾﺎﻣزآمﻮﻠﻋﻪﻠﺠﻣ مرﺎﻬﭼ
)
هرﺎﻤﺷ
1 (
نﺎﺘﺴﺑﺎﺗورﺎﻬﺑ
1389
هدﺮﺘﺴﮔ ﻒﯿﻃ زﺎﺘﮐﻻﺎﺘﺑ يﺎﻫ ﻢﯾﺰﻧآ ﺪﯿﻟﻮﺗ ﺶﯾﺎﻣزآ
)
ESBLs
(
يﺪـﯿﺋﺎﺗﯽﭙﯿﺗﻮـﻨﻓﺖـﺴﺗزارﻮـﻈﻨﻣﻦـﯾاياﺮـﺑ
)
phenotypic
confirmatory tests
(
)ﺪـﺷهدﺎﻔﺘـﺳا
14 درﻮــﻣيﺎـﻫﮏـﺴﯾد .(
ﺪﯿـــــــﺳاﮏﯿﻧﻻوﻼﮐ/ﻢﯾﺪﯾزﺎﺘﻔـــــــﺳﻞﻣﺎـــــــﺷﺶﯾﺎـــــــﻣزآ
g CA
g CAZ
µ µ
10 :
30 :
ﺪﯿـــــــﺳاﮏـــــــﯿﻧﻻوﻼﮐﻢﯿـــــــﺴﮐﺎﺗﻮﻔﺳ،
g CA
g CAZ
µ µ 10
30 :
:
لﻮـﺼﺤﻣ) .دﻮﺑ ﻢﯾﺪﯾزﺎﺘﻔﺳوﻢﯿﺴﮐﺎﺗﻮﻔﺳ،
ﺖﮐﺮﺷ
Mast
.(
تﺪﻣﻪﺑنﻮﯿﺳﺎﺑﻮﮑﻧازاﺪﻌﺑ
24
ردﺖﻋﺎﺳ
37
ﯽﺘﻧﺎﺳ ﻪﺟرد
ﺪﯿﻟﻮﺗ،داﺮﮔ
ESBLs
هزاﺪﻧاﻪﺑﻪﻟﺎﻫﺮﻄﻗﺶﯾاﺰﻓاﻖﯾﺮﻃزا
5
ﯽﻠﯿﻣ
ﯾزﺎﺘﻔﺳﮏﺴﯾدفاﺮﻃاردﺮﺘﺸﯿﺑﺎﯾﺮﺘﻣ
ﻢﯾﺪ
–
ﺪﯿﺳاﮏﯿﻧﻻوﻼﮐ
ﻢﯿﺴﮐﺎﺗﻮﻔﺳﺎﯾو
–
ﻪﻄﺑﺎﺿﻖﺒﻃﺮﺑﺪﯿﺳاﮏﯿﻧﻻوﻼﮐ
Clinical
and Labaratory standards Institute (CSLI)
ﻦﯿﯿﻌﺗ
. ﺪﯾدﺮﮔ
جاﺮﺨﺘﺳا
DNA مﺎﺠﻧاو PCR :
DNA
نﺪﯿﻧﺎﺷﻮﺟشورزاهدﺎﻔﺘﺳاﺎﺑيﺮﺘﮐﺎﺑ
)
boiling
(
ﻖﺒﻃ
ﺮﺨﺘﺳاﺮﯾزﻞﻤﻌﻟارﻮﺘﺳد
.ﺪﺷجا
ﻢﺠﺣ ردﯽﺑوﺮﮑﯿﻣ نﻮﯿﺴﻧﺎﭙﺳﻮﺳ
l µ
500
ﻪﺑﺲﭙﺳ و ﻪﯿﻬﺗ
تﺪﻣ
5
زاﺪﻌﺑ .ﺪﺷهدادراﺮﻗشﻮﺟلﺎﺣرديرﺎﻣﻦﺑردﻪﻘﯿﻗد
تﺪﻣ ﻪﺑ نﺎﻣز ﻦﯾا ﺖﺷﺬﮔ
10
رود رد ﻪﻘﯿﻗد
rpm 14000
يوﺎﺣﯽﯾورزﺎﻓوﺪﯾدﺮﮔژﻮﻔﯾﺮﺘﻧﺎﺳ
DNA
راﺮﻗهدﺎﻔﺘﺳادرﻮﻣ
)ﺖﻓﺮﮔ
15
ﺶﻨﮐاو .(
PCR
ﻨﺷ ياﺮﺑ
يﺎﻫ نژ ﯽﯾﺎﺳﺎ
يزﺎﻣﺎﺘﮐﻻﺎﺘﺑ
blaSHV (214bp)
،
bla TEM (847bp) bla
CTX-m(590bp)
لوﺪﺟ رد جرﺪﻨﻣ ﻂﯾاﺮﺷ ﺖﺤﺗ
1
مﺎﺠﻧا
)ﺪﺷ
16
و
17 .(
ﻢﺠﺣ ردﺶﻨﮐاوطﻮﻠﺨﻣ
l µ
25
ﻞﻣﺎﺷ
TrisHcl 50
،رﻻﻮﻣﯽﻠﯿﻣ
kcl 50
،رﻻﻮﻣﯽﻠﯿﻣ
dNTP 2 /0
،رﻻﻮﻣﯽﻠﯿﻣ
Mgcl2
2
ﻣﯽﻠﯿﻣ
، رﻻﻮ
10
،ﺮﻤﯾاﺮﭘطﻮﻠﺨﻣلﻮﻣﻮﮑﯿﭘ
2
ﺪﺣاو
ﻢﯾﺰﻧآ
Taq DNA polymerase
و
200
مﺮﮔﻮﻧﺎﻧ
DNA .دﻮﺑ
رد هدﺎﻔﺘﺳا درﻮﻣ ﯽﯾﺎﻫﺮﻤﯾاﺮﭘ تﺎﺼﺨﺸﻣ
PCR
لوﺪﺟ رد
2
ﻪﺠﯿﺘﻧ .ﺖﺳا هﺪﺷ هداد ﺶﯾﺎﻤﻧ
PCR
تﺎﻌﻄﻗ ﯽﯾﺎﺳﺎﻨﺷ ياﺮﺑ
يﺎﻫهزاﺪﻧاﺎﺑﯽﺻﺎﺼﺘﺧا
874bp
،
590bp
،
214 bp
يورﺮﺑ
ﺸﻧﺎﺑهاﺮﻤﻫزورﺎﮔآ
هزاﺪﻧاﺮﮕﻧﺎ
100
.ﺪﯾدﺮﮔﻦﯿﯿﻌﺗيزﺎﺑﺖﻔﺟ
Time Temp.(◦C)
Factor Gene
Step
NO.
SHV/CTX-M/TEM SHV/CTX-M/TEM
min
۵
/
۴
/
۵ ٩۴
/
٩۴
/
٩۴
Initial denaturation
١
min
١
/
١
/
١ ٩۴
/
٩۴
/
٩۴
Denaturation
٢
min
١
/
s
٣٠
/
min
١ ۵٨
/
۶٠
/
۶١
Anneling
٣
min
١
/
١
/
١ ٧٢
/
٧٢
/
٧٢
Extension
۴
min
۵
/
۵
/
۵ ٧٢
/
٧٢
/
٧٢
Final extension
۵
٣۵
Cycle number
۶
لوﺪﺟ
1
اﺮﺷ (
مﺎﺠﻧاﻂﯾ PCR
يزﺎﻣﺎﺘﮐﻻﺎﺘﺑﺖﻣوﺎﻘﻣيﺎﻫنژعﻮﯿﺷ
SHV/CTX-M/TEM
رد ...
ﺎﻫﻪﺘﻓﺎﯾ
عﻮﻤﺠﻣزا
246
ﻪﻟوﺰﯾا
Ecoli
يﺎﻫ ﻪﻧﻮﻤﻧزاهﺪﺷاﺪﺟ
)يراردا
50 (% 123
)،ﺪﯿﺳاﮏﯿﺴﮑﯾﺪﯿﻟﺎﻧﻪﺑموﺎﻘﻣﻪﻟوﺰﯾا
1/ 47 (%
116
) ،ﻢﯾﺪﯾزﺎﺘﻔﺳﻪﺑموﺎﻘﻣ ﻪﻟوﺰﯾا
2/ 39 (% 96
ﻪﺑموﺎﻘﻣﻪﻟوﺰﯾا
) ،ﻢﯿﺴﮐﺎﺗﻮﻔﺳ
3/ 33 (% 82
ﻦﯿﺳﺎﺴﮐﻮﻠﻓوﺮﭙﯿﺳ ﻪﺑ موﺎﻘﻣ ﻪﻟوﺰﯾا
)و
3/ 8 (% 20
رادﻮﻤﻧ) .ﺪﻧدادنﺎﺸﻧ ﻢﻨﭘﯽﻤﯾاﻪﺑﺖﻣوﺎﻘﻣﻪﻟوﺰﯾا
1(
نژﻮﯿﻔﯾدرﺎﮔآﮏﺴﯾدﯽﻟﺎﺑﺮﻏنﻮﻣزآزاﻞﺻﺎﺣﺞﯾﺎﺘﻧسﺎﺳاﺮﺑ
) 1/ 47 (% 116
ﻪﺑ (ﻢﯿﺴﮐﺎﺗﻮﻔﺳ ، ﻢﯾﺪﯾزﺎﺘﻔﺳ ﻪﺑ موﺎﻘﻣ) ﻪﻧﻮﻤﻧ
، ﺪﯿﻟﻮﺗﺪﯿﺋﺎﺗ رﻮﻈﻨﻣ
ESBLs
نﻮﻣزآﻖﯾﺮﻃزا
combined
disk
) ﻦﯾا زا ﻪﮐ .ﺖﻓﺮﮔراﺮﻗ ﯽﺑﺎﯾزرا درﻮﻣ
94 (% 109
ﻪﺑ
ﺪﻟﻮﻣناﻮﻨﻋ
ESBLs
ﻞﮑﺷ ).ﺪﺷﯽﯾﺎﺳﺎﻨﺷ
1 (
ﺶﯾﺎﻣزآرد
PCR
ﺮﺑ
نژﺺﯿﺨﺸﺗيا
SHV,CTX-M,
TEM
داﺪﻌﺗزا
109
ﻪﻟوﺰﯾا
ESBLs
ﻪﮐﺪﺷهدادنﺎﺸﻧﺖﺒﺜﻣ
) 6/ 70 (% 77
نژ يارادﻪﻧﻮﻤﻧ
blaSHV
,
) 8/ 68 (% 75
ﻪﻧﻮﻤﻧ
نژياراد
blaCTX-M
)و
1/ 87 (% 95
نژيارادﻪﻧﻮﻤﻧ
blaTEM
) . .ﺪﻧدﻮﺑ
6/ 36 (% 40
.ﺪﻧدﻮﺑ ﺮﻈﻧدرﻮﻣنژ ﻪﺳﺮﻫﺪﺣاوﻪﻧﻮﻤﻧ
ﻦﯾا ﺮﺑهوﻼﻋ
) 3/ 62 (% 68
نژ ودﺪﺟاوﻪﻧﻮﻤﻧ
blaSHV
و
blaTEM
) ،
9/ 55 (% 61
نژود ﺪﺟاو ﻪﻧﻮﻤﻧ
blaTEM
,blaCTX-M
)و
5/ 49 (% 54
نژود ﺪﺟاو ﻪﻧﻮﻤﻧ
blaSHV,blaCTX-M
ﻞﮑﺷ).ﺪﻧدﻮﺑ
2 (
تﺎﺼﺨﺸﻣ
ﺮﻤﯾاﺮﭘمﺎﻧ
يﺪﯿﺗﻮﺌﮐﻮﻧﯽﻟاﻮﺗ
هﺪﺷﯽﯾﺎﺳﺎﻨﺷنژمﺎﻧ
bla SHV
5́-GATGAACGTTTCCCATG ATG-3́
SHV-A
bla SHV
5́-CCC TGT TATCGCTCAGGTAA-3́
SHV-B
bla CTX-M
5́-TTTGCGATGCAT ACC AGT AA-3́
CTX-M-A
bla CTX-M
5́-CGA TAT CGT TGG TGG TGC CAT -3́
CTX-M-B
bla TEM
5́ ATG AGT ATT CAA CAT TTC CG-3́
TEM-A
blaTEM
5́-CTG ACA GTT ACC AAT GCT TA-3́
TEM-B
لوﺪﺟ
2
ردهدﺎﻔﺘﺳادرﻮﻣيﺎﻫﺮﻤﯾاﺮﭘتﺎﺼﺨﺸﻣ :
PCR
ESBLs ﻞﮑﺷ 1
يﺎﻫنژﯽﺳرﺮﺑياﺮﺑيﺪﯿﺋﺎﺗﯽﭙﯿﺗﻮﻨﻓﺖﺴﺗ :
هرود،ﯽﻫﺎﮕﺸﯾﺎﻣزآمﻮﻠﻋﻪﻠﺠﻣ مرﺎﻬﭼ
)
هرﺎﻤﺷ
1 (
نﺎﺘﺴﺑﺎﺗورﺎﻬﺑ
1389
رادﻮﻤﻧ 1
ﯽﺳرﺮﺑدرﻮﻣيﺎﻫﻪﯾﻮﺳﯽﮑﯿﺗﻮﯿﺑﯽﺘﻧآﺖﻣوﺎﻘﻣ :
ﻪﻌﻟﺎﻄﻣﻦﯾارد
E
.c
o
li
ي
ﺎﻫ
ﻪﻟو
ﺰﯾا
داﺪ
ﻌﺗ
ﻞﮑﺷ
2
زرﻮﻓوﺮﺘﮑﻟا:
زورﺎﮔآلژ
123
116
96
82
20
50% 47.10%
39.20%
33.20%
8.30%
0 20 40 60 80 100 120 140
لﺎﻧ
?
ﺲﮐد
?
ساک
?
د
زﺎﺘﻔﺳ
?
د
?
م ﺲﮐﺎﺗ ﻮﻔﺳ
?
م
س
?
سﺎﺴﮐ ﻮﻠﻓوﺮﭘ
?
ن
ا
?
م
?
ﻢﻨﭘ
2،1 )نژياﺮﺑﺖﺒﺜﻣيﺎﻫﻪﻧﻮﻤﻧ :
bp
214 (
blaSHV
،
4،3 )نژياﺮﺑﺖﺒﺜﻣيﺎﻫﻪﻧﻮﻤﻧ :
bp
590 (
blaCTX-M
،
7،6،5
ﻪﻧﻮﻤﻧ :
) نژياﺮﺑﺖﺒﺜﻣيﺎﻫ
bp
847 (
blaTEM
،
8
،ﯽﻔﻨﻣلﺮﺘﻨﮐ :
M ﺮﮐرﺎﻣ :
يزﺎﻣﺎﺘﮐﻻﺎﺘﺑﺖﻣوﺎﻘﻣيﺎﻫنژعﻮﯿﺷ
SHV/CTX-M/TEM
رد ...
ﺚﺤﺑ
ژ
رديزﺎﻣﺎﺘﮐﻻﺎﺘﺑيﺎﻫن
يﺎﻫنژهﮋﯾوﻪﺑيﺮﺘﮐﺎﺑ
ESBLs
،
ﮏﯿﺗﻮﯿﺑﯽﺘﻧآﻪﺑﺖﺒﺴﻧﺖﻣوﺎﻘﻣﺶﯾاﺰﻓاردﺮﺛﻮﻣﻞﻣاﻮﻋزاﯽﮑﯾ
.ﺖﺳا ﻒﯿﻄﻟا ﻊﯿﺳو يﺎﻫ ﻦﯾرﻮﭙﺴﻟﺎﻔﺳ ﻪﻠﻤﺟزا مﺎﺘﮐﻻﺎﺘﺑ يﺎﻫ
ﺚﻋﺎﺑﺪﻨﻨﮐﯽﻣﻞﻤﺣدﻮﺧردارﺎﻫنژﻦﯾاﻪﮐﯽﯾﺎﻫﻢﺴﯿﻧﺎﮔرا
داﺮﻓاﻦﯿﺑردﺮﯿﻣوگﺮﻣوﯽﯾازيرﺎﻤﯿﺑﺶﯾاﺰﻓا
ﻪﭼ،ﺪﻧﻮﺷﯽﻣ
ﻪﺘﺳدﻦﯾازاﯽﯾﺎﻫﺖﻣوﺎﻘﻣدﺎﺠﯾاردﺪﺷرﻪﺑورﺪﻧورﻪﻣاداﺎﺴﺑ
)دﺮﮐﺪﻫاﻮﺧﻪﺟاﻮﻣيﺪﺟﺮﻄﺧﺎﺑارﻪﻌﻣﺎﺟ،
18
و
19 .(
عﻮﻤﺠﻣ زا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد
246
ﻪﻟوﺰﯾا
Ecoli
) 3/ 44 (% 109
ياراد ﻪﻟوﺰﯾا
ESBLs
ﻪﮐ ﯽﺗﺎﻌﻟﺎﻄﻣ رد .ﺪﻧدﻮﺑ
ﺎﺳردﺶﻧارﺎﮑﻤﻫويﺪﺟرﺎﮐﺮﺷﺎﺒﻣﺎﺿﺮﯿﻠﻋﻂﺳﻮﺗ
ل
1387
رد
نﺎﯿﻣزاﺖﻓﺮﮔترﻮﺻﺰﯾﺮﺒﺗ
41
ﯽﻠﮐﺎﯿﺷﺮﺷاﻪﻟوﺰﯾا
40
ﻪﻟوﺰﯾا
) 56 / 97 (% ESBL
ﺖﺒﺜﻣ
).ﺪﻧدﻮﺑ
20
لﻻدنﺎﻄﻠﺳيﺪﻬﻣﺪﻤﺤﻣ (
لﺎﺳ رد
1389
نﺎﯿﻣ زاﻪﮐ دادنﺎﺸﻧ
200
ﯽﻠﮐ ﺎﯿﺷﺮﺷاﻪﻟوﺰﯾا
%) 64 ( 128
ﻪﻟوﺰﯾا
ESBL
) داﺪﻌﺗﻦﯾازاﻪﮐﺪﻧدﻮﺑﺖﺒﺜﻣ
8/ 57 (%
74
نژ يوﺎﺣ
TEM
) ﺪﻧدﻮﺑ
21 .( Meyer
رد ﺶﻧارﺎﮑﻤﻫ و
)لﺎﺳ
2008
ﯽﻠﮐﺎﯿﺷﺮﺷا يﺎﻬﻠﯿﺳﺎﺑﯽﻧاواﺮﻓ ﻪﮐﺪﻧدادنﺎﺸﻧ (
ﺪﻟﻮﻣ يﺎﻫ
ESBl
رد
ICU
زانﺎﻤﻟآرﻮﺸﮐ يﺎﻫ
0/ 14
رد %
لﺎﺳ
2001
ﻪﺑ
1/ 52
لﺎﺳرد %
2007
ﻪﮐﺪﻧﺪﻘﺘﻌﻣﻦﯿﻘﻘﺤﻣ.ﺪﯿﺳر
ﻪﺑ موﺎﻘﻣ يﺎﻫ ﺎﯿﺷﺮﺷا ﻪﺑ ﻪﺟﻮﺗ
ESBL
يا هﮋﯾو ﺖﯿﻤﻫا
).دراد
22 (
ناﺰﯿﻣ
ESBL
ﻪﯾﻮﺳرد
ﻒﻠﺘﺨﻣيﺎﻫرﻮﺸﮐزاهﺪﺷﻪﻟوﺰﯾايﺎﻫ
ﺮﮕﯾدنﺎﺘﺳرﺎﻤﯿﺑﺎﺑ نﺎﺘﺳرﺎﻤﯿﺑﮏﯾزارﻮﺸﮐﮏﯾردﻦﯿﻨﭽﻤﻫو
ﺖﻧﻮﻔﻋلﺮﺘﻨﮐﻢﺘﺴﯿﺳﻪﺑﯽﮕﺘﺴﺑﻪﻠﺌﺴﻣﻦﯾاﻪﮐﺪﺷﺎﺑﯽﻣتوﺎﻔﺘﻣ
.درادﯽﻧﺎﻣردﻢﯾژرو
شور ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا رد
PCR
،
6/ 70
نژ يوﺎﺣ %
SHV
،
8/ 68
نژيوﺎﺣ %
CTX-M
و
1/ 87
نژيوﺎﺣ %
TEM
ﺪﻧدﻮﺑ
رد.
لﺎﺳردنارﺎﮑﻤﻫﺮﯾﺎﺳوﯽﻧﺎﯾﺰﻣﻂﺳﻮﺗﻪﮐﯽﺗﺎﻌﻟﺎﻄﻣ
1386
رد
ﺖﻓﺮﮔ ترﻮﺻ ناﺮﻬﺗ ﺮﺼﻌﯿﻟو نﺎﺘﺳرﺎﻤﯿﺑ
،
نﺎﯿﻣ زا
76
ﻪﻧﻮﻤﻧ
ﯽﻨﯿﻟﺎﺑ
E.coli )،
60 (% 47
نژ يوﺎﺣ ﻪﻟوﺰﯾا
TEM
) ﺪﻧدﻮﺑ
23 .(
نﺎﯿﻣ زا ﻪﮐ داد نﺎﺸﻧ نﺎﯾﺪﺠﺴﻣ
148
ﻪﯾﻮﺳ
Ecoli
،
4/ 86 %
نژﺎﻫﻪﻟوﺰﯾا
TEM
ﺎﺑﻪﺑﺎﺸﻣرﺎﯿﺴﺑناﺰﯿﻣﻦﯾاﻪﮐﺪﻨﺘﺷادﺮﺑردار
)دﻮﺑﻖﯿﻘﺤﺗﻦﯾا زاﻞﺻﺎﺣ ﺞﯾﺎﺘﻧ
24
ﻂﺳﻮﺗ ﻪﮐﯽﻘﯿﻘﺤﺗردو.(
ﺪﺷ مﺎﺠﻧا نﺎﯿﺤﻟﺎﺻ ﺮﯿﻣ
،
نﺎﯿﻣزا ﻪﮐ ﺪﺷ هداد نﺎﺸﻧ
33
ﻪﯾﻮﺳ
ﯽﻠﮐﺎﯿﺷﺮﺷا
،
4/ 39
نژيوﺎﺣﻪﻟوﺰﯾا%
ﺪﻧدﻮﺑيزﺎﻣﺎﺘﮐﻻﺎﺘﺑ
) 25
ﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ زا هﺪﻣا ﺖﺳد ﻪﺑ ﺞﯾﺎﺘﻧ ﻪﺴﯾﺎﻘﻣ.(
ﺎﺑ ﺮ
ردﯽﻤﯾﺰﻧاﭗﯿﺗﻦﯾايﻻﺎﺑعﻮﯿﺷهﺪﻨﻫدنﺎﺸﻧرﻮﮐﺬﻣتﺎﻌﻟﺎﻄﻣ
ﯽﻨﯿﻟﺎﺑيﺎﻫﻪﯾﻮﺳ
E.coli
ﯽﻬﺑﺎﺸﻣتﺎﻌﻟﺎﻄﻣ .ﺪﺷﺎﺑﯽﻣﺎﻣرﻮﺸﮐرد
ﻪﮐ ﺪﺷ هداد نﺎﺸﻧ ﻪﯿﮐﺮﺗ رد
7/ 52
ﯽﻠﮐﺎﯿﺷﺮﺷا يﺎﻫ ﻪﯾﻮﺳ %
ﺪﯿﻤﺳﻼﭘياراد
TEM 3 / 74
نژياراد %
SHV
،
4/ 32
ياراد %
)ﺪﻧا هدﻮﺑ ﺪﯿﻤﺳﻼﭘ ود ﺮﻫ
26
ﮕﯾد ﻪﻌﻟﺎﻄﻣ رد.(
ﻂﺳﻮﺗ ﻪﮐ يﺮ
Shahid
نژعﻮﯿﺷ،ﺪﺷمﺎﺠﻧاﺶﻧارﺎﮑﻤﻫو
blaCTX-M
ردار
93
ﻪﻧﻮﻤﻧ
E.coli
ﺪﻧدﺮﮐﺺﺨﺸﻣو .ﺪﻧدادراﺮﻗﯽﺳرﺮﺑدرﻮﻣ
زاﻪﮐ
93
،ﻪﻧﻮﻤﻧ
72
) ﻪﻧﻮﻤﻧ
4/ 77
ﻪﻠﯿﺳوﻪﺑ (%
PCR
،
CTX-M
)ﺪﻧدﻮﺑ ﺖﺒﺜﻣ
27
ﻂﺳﻮﺗ هﺪﺷ مﺎﺠﻧا ﻪﻌﻟﺎﻄﻣ رد.(
Burcu Bali
،
نﺎﯿﻣزاﺪﺷهدادنﺎﺸﻧ
44
ﮐﺎﯿﺷﺮﺷاﻪﻧﻮﻤﻧ
ﯽﻠ
72 / 72 )% 32
ياراد(
نژ
TEM
و
72 / 22 )% 10
نژياراد(
CTX-M
) ﺪﻧدﻮﺑ
28 .(
يﺎﻫ نژ يﻻﺎﺑ عﻮﯿﺷ هﺪﻨﻫد نﺎﺸﻧ ﻪﺘﻓﺮﮔ ترﻮﺻ تﺎﻌﻟﺎﻄﻣ
ﭗﯿﺗ صﻮﺼﺧ ﻪﺑ يزﺎﻣﺎﺘﮐﻻﺎﺘﺑ
TEM
ﺎﯿﺷﺮﺷا يﺎﻫ ﻪﯾﻮﺳ رد
عﻮﻧﻦﯾاﯽﺋﺎﺳﺎﻨﺷياﺮﺑﻪﮐﺖﺳايروﺮﺿﻦﯾاﺮﺑﺎﻨﺑﺪﺷﺎﺑﯽﻣﯽﻠﮐ
شوررﺎﻨﮐردﯽﻟﻮﮑﻟﻮﻣيﺎﻫشورزاﺖﻣوﺎﻘﻣزا
ﯽﭙﯿﺗﻮﻨﻓيﺎﻫ
.دﻮﺷهدﺎﻔﺘﺳا
هﺪﻨﻨﮐﺪﯿﻟﻮﺗازﺖﻧﻮﻔﻋﻞﻣاﻮﻋﻪﺑﻼﺘﺒﻣﻪﮐﯽﻧارﺎﻤﯿﺑ
ESBL
ﻒﯿﻄﻟاﻊﯿﺳويﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧآﺎﺑنﺎﻣردمﺪﻋﺮﺑهوﻼﻋﺪﻨﺘﺴﻫ
.ﺪﻨﻫدﯽﻣنﺎﺸﻧﺖﻣوﺎﻘﻣﺰﯿﻧﺎﻫﮏﯿﺗﻮﯿﺑﯽﺘﻧاعاﻮﻧاﺮﯾﺎﺳﻪﺑًﺎﺒﻟﺎﻏ
ESBLs
هدﻮﺑرادرﻮﺧﺮﺑﯽﻧﺎﻣرديﮋﺗاﺮﺘﺳاردﯽﺻﺎﺧﺖﯿﻤﻫازا
ﺖﺳا
زاﻞﺻﺎﺣﯽﻧﺎﻣرديﺎﻫﺖﺴﮑﺷﺖﻠﻋﻪﺑعﻮﺿﻮﻣﻦﯾااﺮﯾز.
ﺖﺳا ﺖﯿﺳﺎﺴﺣ ﻦﯿﯿﻌﺗ ﺖﺴﺗمﺎﺠﻧا نوﺪﺑﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺰﯾﻮﺠﺗ
نﺪﺷ ﯽﻧﻻﻮﻃوﺮﯿﻣوگﺮﻣ ﺶﯾاﺰﻓاﯽﯾﺎﺳﺎﻨﺷﺚﻋﺎﺑدﻮﺧ ﻪﮐ
)ددﺮﮔ ﯽﻣ نﺎﻣرد ﻪﻨﯾﺰﻫ ﺶﯾاﺰﻓا و يﺮﺘﺴﺑ نﺎﻣز
29
ﻦﯾاﺮﺑﺎﻨﺑ .(
هﺪﻨﻨﮐﺪﯿﻟﻮﺗيﺎﻫﻪﯾﻮﺳﻊﯾﺮﺳﯽﯾﺎﺳﺎﻨﺷ
ESBLs
هﺎﮕﺸﯾﺎﻣزآرد
ﻫ
.ﺖﺳايروﺮﺿوﻢﻬﻣرﺎﯿﺴﺑﯽﺳﺎﻨﺷبوﺮﮑﯿﻣيﺎ
يﺮﯿﮔﻪﺠﯿﺘﻧ
ﺪﯿﻟﻮﺗ
ESBLs
فﺮﺼﻣ ياﺮﺑگرﺰﺑﺪﯾﺪﻬﺗﮏﯾناﻮﻨﻋ ﻪﺑ
ياﺮﺑ ﻦﯾاﺮﺑﺎﻨﺑ دور ﯽﻣ رﺎﻤﺷ ﻪﺑ ﻊﯿﺳو ﻒﯿﻃ ﺎﺑ ﻦﯾرﻮﭙﺴﻟﺎﻔﺳ
هﺪﻨﻨﮐﺪﯿﻟﻮﺗيﺎﻫ ﻢﺴﯿﻧﺎﮔراكﻮﮑﺸﻣﻪﮐ يﺎﻫﺖﻧﻮﻔﻋ نﺎﻣرد
ﻨﭽﻤﻫ .دﻮﺷبﺎﺨﺘﻧاﺖﻗدﻪﺑﺐﺳﺎﻨﻣﮏﯿﺗﻮﯿﺑﯽﺘﻧآﺪﯾﺎﺑﺪﻨﺘﺴﻫ
ﻦﯿ
و ﻢﯾﺪﯾزﺎﺘﻔﺳ ﺮﺑاﺮﺑ رد ﺎﻫ نآ ﺖﯿﺳﺎﺴﺣ ﻪﮐ يﺎﻫ شﻮﺳ
يﺎﻫنژﻦﺘﺷادﺮﻈﻧزاﺪﯾﺎﺑﺖﺳاهدﺮﮐاﺪﯿﭘﺶﻫﺎﮐﻢﯿﺴﮐﺎﺗﻮﻔﺳ
.ﺪﻧﺮﯿﮕﺑراﺮﻗﯽﺳرﺮﺑدرﻮﻣ
8
/
هرود،ﯽﻫﺎﮕﺸﯾﺎﻣزآمﻮﻠﻋﻪﻠﺠﻣ مرﺎﻬﭼ
)
هرﺎﻤﺷ
1 (
نﺎﺘﺴﺑﺎﺗورﺎﻬﺑ
1389
S.Rapid Detection of Extended Spectrum B-Lactamases (ESBL) for Entrobacteriaceae by use of a Multiplex PCR-based Method .2009;41(3):181-184.
17.Amaral S,Peixe L,Machado E.Characterization of CTX-M Type extended-spectrum beta-lactamases(ESBLs) among entrobacteriaceae from a Portuguese hospital. 2009;6:259-263.
18.Poirel L, Weldhagen GF ,Naas T ,De Champs C, Dove MG12-, Nordmann P. GES-2, a class A beta-lactamase from Pseudomonas aeruginosa with increased hydrolysis of imipenem. Antimicrob Agents Chemother. 2001; 45(9):2598-603.
19.Branger C, Zamfir O, Geoffroy S, Laurans G,Arlet G, Thien H, et al. Genetic Background of Escherichia coli and Extended-Spectrum Beta- Lactamase type. Emerg Infect Dis. 2005; 11(1):54-61.
20.Mobasher-kare-Jeddi AR,Nahaei MR,Mobayyen H,Pornour M,Sadeghi J.Molecular study of extended-spectrum beta-lactamase(SHV Type)in Esherchia Coli and Klebsiella penumoniae isolated from Medical Centers of Tabriz. Iran J Med Microbiol.2008; 3,4:9-17.
21.Soltan-Dallal MM,Molla-Aghamirzaei H,Sabbaghi A,Eshraghian MR. Molecular detection of TEM and AmpC (Dha, mox) broad spectrum β-lactamase in clinical isolates of Escherichia coli .Tehran University Medical Journal.2010; 68( 6): 315-320.
22- Meyer E , GastmeierP, Schwab F. The burden of multiresistant bacteria in German intensive care units. Journal of Antimicrobial Chemotherapy. 2008. 62(6):1474-1476.
23- Hosseini –Mazinani SM,Eftekhar F,Milani M,Gandili.Characterization of β-lactamase from Urinary Isolated of Escherichia coli in Tehran. Iranian Biomedical Jurnal.2007.l.11(2):95-99.
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