产超广谱β-内酰胺酶克雷伯菌监测及与临床抗生素应用的关系

Inspection of ESBLs produced by klebsiella and the relation to the application of clinical antibiotics

目的了解产超广谱β内酰胺酶(ESBLs)克雷伯菌在临床科室的分布和医院感染情况,以及与临床抗生素应用的关系。方法湖南省儿童医院于2003年6月至2004年9月,对临床检出菌,用法国生物梅里埃系统鉴定,以KB法进行药敏分析,用双纸片法对分离的克雷伯菌进行ESBLs检测,同时对患儿的医院感染情况和ESBLs检测前的抗生素应用情况进行回顾性调查。结果14704份标本共检出克雷伯菌305株,其中肺炎克雷伯菌282株。305株克雷伯菌中医院感染51株(16.7%);产ESBLs菌111株(36.4%)。新生儿科和ICU病房产ESBLs菌的比率和医院感染比率均显著高于其他病房,同时发生二重感染的克雷伯菌产ESBLs比率显著高于无二重感染菌。在11种抗生素中,亚胺培南的耐药率最低,其次为环丙沙星。产ESBLs菌患儿检测前使用任何抗生素及使用第三代头孢菌素的比率分别为90.1%(100/111)、71.2%(79/111),感染但未产ESBLs菌的患者检测前使用任何抗生素及使用第三代头孢菌素的比率分别为67.5%(131/194)、18.6%(36/194),两者比较差异有显著性(P<0.005,P<0.005)。结论克雷伯菌医院感染与产ESBLs菌在临床的分布有关,第三代头孢菌素的应用是ESBLs菌产生的危险因素,抗生素与酶抑制的复方制剂和亚胺培南是治疗感染产ESBLs克雷伯菌的有效药物。

Objective To understand the relationship among the clinical distribution of klebsiella producing extend-spectrum β-1actamases （ESBLs） , the instance of nosocomial infection and the application of clinical antibiotics. Methods The bacteria which were isolated from June 2003 to September 2004 in our hospital were indentified by API system. A K- B test analysed the antimicrobial susceptibility and a double disk test detected ESBLs in the isolated klebsieUa. The application of antibiotics in the patients before ESBLs were detected and the instances of nosocomial infection were investigated. Results A total of 305 strains of klebsieUa were gained from the 14704 specimen;282 of the 305 strains were K. pneumoniae. In the 305 strains,51（ 16.7% ） were from hospital. 111 （36.4%） of the 30 stains were ESBLs. The rate of ESBLs strains and the rate of nosocomial infection in the neonate department and intensive care unit （ ICU ） were significantly higher than those in other departments. The percentage of producing ESBLs in the klebsiella causing superinfection was significantly higher than that in the non- superinfection strains. The resistance rate of IPM was the lowest in the eleven antibiotics ;CIP was the later. The percentage of using any antibiotics and using the third generation cephalosporin before detection in the patients infected with ESBLs strains were 90. 1% （ 100/111 ） and 71.2% （79/111 ） respectively,which was significantly higher than those in the patients infected with non-ESBLs [ 67. 5% （ 131/194）, 18. 6% （36/194） ]. The difference was significant between the two groups （ P 〈 0. 005 ）. Conclusion The nosocomial infection of klebsieUa is related to the clinical distribution of the ESBLs strains. The using of the third generation cephalosporins is a risk factor of producing ESBLs. IPM and the compound preparations of antibiotics and enzyme inhibitor are the effective drugs to treat the patients infected with ESBLs klebsiella.