社区感染中革兰阴性杆菌的超广谱β-内酰胺酶的检测及耐药性分析

Detection of extended-spectrum β-lactamase and analysis of antibiotics resistance in clinical isolates among community-acquired infections

目的检测社区革兰阴性杆菌ESBLs的产生及其对11种抗生素的耐药性。方法采用双纸片扩散法对临床分离的革兰阴性杆菌进行ESBLs检测,体外药敏实验采用K-B法,实验数据处理使用χ2检验。结果社区感染革兰阴性杆菌以大肠杆菌、肺炎克雷伯菌、铜绿假单胞菌为主。社区感染革兰阴性杆菌ESBLs总阳性率为17.6%,其中阴沟杆菌、肺炎克雷伯菌和大肠杆菌的ESBLs阳性率分别为23.5%、18.5%和18.1%。社区感染阴性杆菌的ESBLs总阳性率(17.6%)显著低于医院感染(29.7%)(χ2检验,P<0.05)。除泰能、阿米卡星、派拉西林/他唑巴坦、舒普深四种抗生素外,社区感染产ESBLs阴性杆菌对其余七种抗生素(庆大霉素、头孢他啶、环丙沙星、头孢噻肟、头孢吡肟、氨曲南、头孢哌酮)的耐药性与不产ESBLs阴性杆菌相比有显著性差异(χ2检验,P<0.05)。社区感染和医院感染中分离的革兰阴性杆菌对泰能的耐药率分别为0和0.5%,两者相比无显著性差异(χ2检验,P<0.05)。社区感染革兰阴性杆菌对除泰能外的其他抗生素的耐药率与医院感染菌株相比均有显著性差异(χ2检验,P<0.05)。结论社区感染革兰阴性杆菌耐药性颇为严峻,社区感染患者乱用和盲目使用抗生素是导致其耐药性的重要原因,ESBLs的产生也不容忽视。应加强抗菌药物的管理,减少患者滥用抗生素及加强?

Objective: To determine the productive rates of extended-spectrum β-lactamase(ESBLs) in the clinical isolates of Gram-negative bacteria in community-acquired infections, and investigate their resistance to 11 kinds of antibiotics. Methods: ESBLs were detected by the double disc diffusion method among clinical isolates of gram-negative bacteria. Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion method. The χ2 test was used to analyze test results. Results: In the clinical isolates of community-acquired infections, E.colithe﹑P.aeruginosa and K.pneumoniae were the most usual pathogens. The productive rate of ESBLs detected among community-acquired infections was 17.6%, the productive rate of E.cloacae and K.pneumoniae and E.coli were 23.5%, 18.5% and 18.1% respectively. The productive rate of ESBLs detected among community-acquired infections (17.6%) was significantly lower than that of hospital infections (χ2 test, P<0.05). Except Cefoperazone/sulbactam, Amikacin, Imipeum Piperacilin/Tazobactams,there were significant differences between the resistance of ESBLs-producing strains to other seven kinds of antibiotics (gentamycin, ceftazidime, ciprofloxime cefepime, aztreonam, cefoperazone) and that of non-ESBLs-producing strains(χ2 test,P<0.05). The resistance rates of community-acquired and hospital strains to Imipenum were 0 and 0.5% respectively, there was no significant difference between them (χ2 test,P<0.05). Excluding Imipenum,the resistance rates of other antibiotics of the clinical isolates detected among community-acquired infections were both significantly lower than those among hospital infections (χ2 test,P<0.05). Conclusions: The drug-resistance of Gram-negative bacteria detected among community-acquired infections is serious, for which the drug abusing and ESBLs are important factors. Strengthened the supervision towards antibiotics and decreased the abusing of antibiotics, should be given.