产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性研究

Study of antibiotic resistance in ESBLs-producing strains

目的:了解我院临床分离产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的检出率及耐药性情况,为指导临床用药提供依据。方法:对我院1999-2005年分离的854株大肠埃希菌、300株克雷伯菌用标准纸片扩散确证法检测其ESBLs产生率;采用K-B法进行药敏检测。结果:1999年我院产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为26.4%和21.9%,2005年的两者检出率分别增长为48.6%和47.7%。除亚胺培南的耐药率为0%、产ESBLs大肠埃希菌和肺炎克雷伯菌对阿米卡星、呋喃妥因的耐药率分别为17.9%和6.2%外,2005年我院产ESBLs菌株对其他抗菌药物耐药率均达74.4%以上,且产ESBLs菌株的耐药率远高于非产ESBLs菌株。结论:医院应重视对产ESBLs菌株的检测,合理选用抗菌药物治疗感染。对于产ESBLs大肠埃希菌和肺炎克雷伯菌感染的治疗,亚胺培南应作为首选药物。

OBJECTIVE To investigate the productive status and the antibiotic resistance of extended spectrum beta lactamases （ESBLs） in Escherichia coli and Klebsiella pneumoniae so as to provide necessary grounds to the clinical practice. METHODS A total of 854 strains of E. coli and 300 strains of K. pneumoniae were collected from clinical specimens. ESBLs production was performed by the standard disk diffusion method; drug susceptibility was detected by Kirby Bauer disk diffusion method. RESULTS ESBLs productive rate of E. coli （K. pneumoniae） increased significantly from 26. 4% （21.9%） to 48.6% （47. 7%） at our hospital, during the years from 1999 to 2005. No strains were found to be resistant to imipenern. The resist ance rates of ESBLs-producing E. coli strains to amikacin and nitrofurantoin were 17. 9% and 6. 2%, respectively, and over 74. 4% to other antibiotics at 2005. The resistances of ESBLs-producing strains to most antimicrobials were much higher than that of non ESBLs-producing strains. CONCLUSION Antibiotics should be used rationally in the treatment of infections caused by ESBLs-producing strains. Imipenem could be of the first choice to treat the infection caused by ESBLs-producing strains.