术后患者肺部感染产ESBLs细菌的检测和耐药性分析

Detection of ESBL-producing strains isolated from patients with postoperative lung infections and antimicrobial resistance analysis

目的 对某院手术后患者肺部感染菌产超广谱β内酰胺酶(ESBLs)的情况及其对常用抗菌药物的耐药性进行监测,为临床合理用药提供依据。方法 采集2 0 0 3年1月- 2 0 0 4年12月间术后发生肺部感染患者的血、痰及尿标本,进行细菌分离、ESBLs检测和药物敏感试验。结果 88.6 4 % (39/ 4 4)的肺部感染患者分离出细菌,共4 7株,其中产ESBLs菌12株,占2 5 .5 3%。产ESBLs菌感染患者的总住院天数、术后住院天数及发热天数显著高于非产ESBLs菌感染患者(P <0 .0 1) ,术前应用抗菌药物比率亦显著高于后者(P <0 .0 5 )。产ESBLs菌对青霉素类、大部分头孢菌素类和单环类抗生素耐药率>90 % ,对三代头孢菌素、单环类及部分喹诺酮类和加酶抑制剂的复合药的耐药率均明显高于非产ESBLs菌(均P <0 .0 5 )。结论 术后患者肺部感染产ESBLs细菌较常见,对临床治疗及患者的术后恢复不利;其耐药性监测对临床用药具有重要指导意义。

Objective To study the epidemic of ESBL-producing strains isolated from patients with postoperative lung infection and drug resistance to commonly used antimicrobial agents, and provide reference for empirical treatment of postoperative lung infections. Methods Blood, sputum and urine samples were collected from patients with postoperative lung infections from January 2003 to December 2004, bacteria were isolated for ESBL detection and antimicrobial susceptibility test. Results Forty-seven strains of bacteria were isolated from 88.64% (39/44) of patients with lung infection, 12 strains (25.53%) produced ESBL. The total hospitalization days, postoperative hospitalization days and fever duration in patients with ESBL-producing strain infection were obviously longer than those in patients with non-ESBL-producing strain infection (P< 0.01 ), the application of antimicrobial agents before the operation was also common (P< 0.05 ). The resistant rates of the ESBL-producing strains to penicillins, most cephalosporins and monobactams were over 90%, and the resistant rates of the ESBL-producing strains to the third generation cephalosporins, monobactams, part of fluoroqinolones and drugs with enzyme inhibitors were significantly higher than those of the non-ESBL-producing strains (P< 0.05 ). Conclusion ESBL-producing strains are very common in postoperative lung infection, which produce difficulties for clinical treatment and recovery of the patients. Monitoring of antimicrobial susceptibility of ESBL-producing bacteria is important for clinical treatment.