肺炎克雷伯菌和大肠埃希菌超广谱β-内酰胺酶检测与分析

Detection and Analysis of Extended-spectrum β-lactamases in Klebsiella Pneumoniae and Escherichia Coli

目的:掌握肺炎克雷伯菌和大肠埃希菌中超广谱β－内酰胺酶发生率及对多种抗生素耐药现状,比较三种检测方法。方法;按美国临床实验室标准化委员会(ＮＣＣＬＳ)１９９９年版推荐的纸片扩散法的筛选试验和确证试验,同时以非ＮＣＣＬＳ推荐的双纸片协同法检测超广谱β－内酰胺酶。结果:超广谱β－内酰胺酶发生率肺炎克雷伯菌３５．８%,大肠埃希菌３４．１%。超广谱酶株对多种抗生素耐药率高。确证试验与协同试验相符率高。结论:本院肺炎克雷怕菌和大肠埃希菌超广谱β－内酰胺酶发生率高,临床应慎用第三代头孢菌素和氨曲南。筛选法可疑株必须做确证试验。协同试验直观,便于观察,有一定的漏检率和误检率。纸片间距离问题不宜规定统一标准。

ves: To find out the positive rate of extended-spectrum β-lactamases (ESBLs) in K. pneumonias and E. coli and their multiple drug resistant status. Methods: Three methods, the screening test and confirmation test of dots pervasion method recommended by NCCLS in 1999 and the dots synergy method, were used in the detection of ESBLs and the results were compared. Results: The positive rates of ESBLs in K. pneumoniae and E. coli were 35. 8% and 34. 1% respectively. The drug resistant rate in ESBLs positive strains was high. The coincident rate between the conformation test and synergy test was high. Conclusions: The positive rate of ESBLs in K. pneumoniae and E. coli in our hospital is high. Caution should be paid when the third generation of cephalosporins and aztreonam are used. Suspected resistant strains in filtration test must be corroborated. The synergy test is direct and easy to observe, but there exist certain undetected and false rates.