大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶菌株的耐药性监测

ESBLs-producing Escherichia coli and Klebsiella pneumoniae: An Antibiotic-resistance Analysis

目的 了解医院临床分离出的产超广谱β-内酰胺酶 (ESBL s)的主要细菌 ,大肠埃希菌和肺炎克雷伯菌中产 ESBL s菌株的构成比和耐药特征 ,为临床抗感染治疗提供参考。方法 2 0 0 2年 1～ 12月从本院住院患者的各类临床标本 ,采用 Kirby- Bauer(K- B)琼脂扩散法和 ESBL s确证试验进行 ESBL s的检测。结果 大肠埃希菌、肺炎克雷伯菌产 ESBL s菌株的检出率分别为 4 3.7%和 35 .3% ;产 ESBL s菌株较不产 ESBL s菌株表现为对抗菌药物明显高的耐药率 ,除个别抗菌药物外 ,两者差异具有显著性 P值 <0 .0 5 ,以及高多重耐药率 ;产 ESBL s的大肠埃希菌、肺炎克雷伯菌对亚胺培南耐药率最低 ,分别是 4 .5 %和 2 .1% ,其次是阿米卡星、头孢哌酮 /舒巴坦 ,对其他抗菌药物的耐药率均 >70 %。结论 产 ESBL s菌株感染给临床治疗带来较大困难 ,遏制产 ESBL s菌株的产生 ,要加强细菌耐药性监测、合理应用抗菌药物。

OBJECTIVE To survey the constituent ratio and drug-resistance characteristics of ESBLs-producing bacteria-Escherichia coli and Klebsiella pneumoniae. METHODS Isolation, cultivation, identification, drug-sensitivity tests, and confirmation of ESBLs-producing bacteria were done for all the bacterial specimens collected from our hospital in 2002. Susceptibility testing was performed by disk diffusion (K-B) method. RESULTS The constituent ratios of E.coli and K.pneumoniae, which could produce ESBLs, were 43.7% and 35.3%, respectively at our hospital in 2002. The MDR (multi-drug-resistance) rate of ESBLs-producing strains was higher than that of strains no producing ESBLs (P<0.05). The ESBLs-producing strains of E.coli and K.pneumoniae were sensitive to imipenem, and their resistance rates to imipenem were 4.5% and 2.1%, respectively. The resistance rates of ESBLs-producing E.coli strains to amikacin, cefoperazone/sulbactam (Sulperazon) were 24.6% to 31.4%. The resistance rate of K.pneumoniae strains to Sulperazon was 42.5%, and over 70% to other antibiotics. CONCLUSIONS The high constituent ratio of ESBLs-producing bacteria and high MDR rates make them very tough for clinical treatment of infection, which suggests that it be urgent to reducing the amount of ESBLs-producing bacteria. Wide-spectrum antibiotics should be applied strictly.