医院获得性下呼吸道感染阴沟肠杆菌的耐药性分析

Antibiotic resistance of Enterobacter cloacae in nosocomial low respiratory tract infection

目的了解医院获得性下呼吸道感染阴沟肠杆菌临床分离株耐药性与超广谱β-内酰胺酶的发生率.方法分析2001年3月～2003年5月126例医院获得性阴沟肠杆菌下呼吸道感染患者的分离菌,采用纸片扩散表型试验检测超广谱β-内酰胺酶(ESBLs).结果阴沟肠杆菌产ESBLs率为29.4%,呼吸内科、胸外科、神经科等重症监护室(ICU)分离的阴沟肠杆菌产ESBLs率为44%,明显高于普通病房分离的阴沟肠杆菌的产ESBLs率(7.8%,P＜0.005).产ESBLs阴沟肠杆菌对氨苄青霉素、环丙沙星及头孢他啶等头孢菌素的耐药率分别为100%、92.1%和100%.除哌拉西林和亚胺培南外,产ESBLs阴沟肠杆菌对常用12种抗菌药物的耐药性明显高于不产ESBLs菌.亚胺培南对产ESBLs与不产ESBLs的阴沟肠杆菌的抗菌活性均较高.结论阴沟肠杆菌ESBLs的检出率为29.4%,各科ICU阴沟肠杆菌ESBLs检出率更高.临床可选亚胺培南进行治疗.

Objective To investigate the prevalence of nosocomial low respiratory tract infection by Enterobacter cloacae and survey the resistance and occurrence of ESBLs-producing strains. Methods Total of 126 cases with hospital acquired low respiratory infection by Enterobacter cloacae were collected from March 2001 to May 2004. Bacterial identification was done by Microscan Walk Away-40. ESBLs were detected by standard plate. Results The occurrence of ESBLs-producing strains of Enterobacter cloacae was 29. 4% while in ICU was 44%. It was significantly higher in ICU than that in general wards （7.8%, P〈0. 005）. The resistant rate of ESBLs-producing strains to ampicillin, Ciprofloxacin and ceftazidime were 100%, 92.10% and 100%, respectively. The resistant rate of ESBLs-producing strains against most antibiotics was significantly higher than that of non-ESBLs-producing strains. Imipenem showed strong antimicrobial activity to most isolates. Conclusion The detection rate of ESBLs-producing bacteria was 29.4%. Those were mainly isolated from ICU, and mostly susceptible to imipenem.