产ESBL菌流行趋势及耐药趋势分析

Investigation of Changing Trends of the Epidemiology and Antibacterial Susceptibility of ESBL-producing Strains

目的分析产超广谱β内酰胺酶(ESBL)肺炎克雷伯氏菌及大肠埃希氏菌的流行趋势和耐药趋势,为临床合理选择抗生素提供依据。方法对本院2003年1月～2004年12月临床标本中分离的肺炎克雷伯氏菌和大肠埃希氏菌,采用Vitek32全自动细菌鉴定和药敏分析仪进行ESBL检测,药敏实验,及其变化趋势分析。结果2003年有33.3%的肺炎克雷伯氏菌和35.3%大肠埃希氏菌产ESBL,2004年则为29.3%和32.2%;两年相比产ESBL菌分离率差异无显著性意义(P>0.05);两年中产ESBL菌对青霉素类、头孢菌素类和单环类抗生素耐药率在90%以上,产ESBL和不产ESBL菌株对亚胺培能均未发现耐药。产ESBL菌株三代头孢菌素、单环类、氨基糖苷类、喹诺酮类的耐药率两年间对比差异无显著性意义(P>0.05)。结论2003、2004年ESBL细菌的分离率及耐药性无明显差异,趋势监测对临床用药具有指导意义。

Objective： To investigate the changing trends of epidemiology and antibacterial susceptibility of ESBL-producing strains in K pneumonia and E coli and to provide suggestions empirical treatment against the kind of bacteria. Methods： Nine hundred and fifteen strains of E. coli and K pneumonia from January 2003 to December 2004 were investigated for the production for ESBL, antibacterial susceptibility test by Vitek-32, and its changing trends. Results：Among the strains, 33.3% of K pneumonia and 35. 3% of E. coli produced ESBL in 2003, 29. 3% and 32. 2% in 2004; Campared with the results of 2003, the frequency of occurrence showed no significant change（ P〉0. 05 ）. The resistance rate of the ESBL-producing strains to penicillin, cefotaxime, ceftriaxone, ceftazidime, aztreonam were over 90%, and the resistance rates of the ESBL-producing strains of 2003 to the third generation cefhalosorins, aminoglycosides, quinolones, amoxicillin/clavulanate, pipepracillin/tazobactam showed no significant change compared with those strains of 2004（P〉0.0,5）; There was no increased trend over the monitored period（P〉0.05）. All of the ESBL-producing and the Non-ESBL-producing strains were susceptible to imipenem. Conclusion： Monitoring the prevalence and changing trends of ESBL-producing bacteria is important for clinical treatment.