产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的分布及耐药性分析

Distribution and drug resistance analysis of Escherichia coli and Klebsiella pneumoniae producing extended spectrum beta-lactamases

目的了解医院产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌的分布及耐药性特点。方法对我院2004年7月～2006年7月间各类临床标本分离出的大肠埃希菌307株和肺炎克雷伯菌202株，用CLSI／NCCLS推荐的表型确证法检测其ESBLs，采用K-B纸片琼脂扩散法进行药敏试验，分析产ESBLs菌株的分布及耐药性。结果大肠埃希菌和肺炎克雷伯菌产ESBLS菌株的检出率分别为38．4％（118／307）和31．7％（64／202），主要分布于尿和痰、咽拭子中，病区主要集中于肺科、神经外科、感染科、泌尿外科、ICU室。产ESBLs菌株对亚胺培南和美罗培南呈高度敏感，对哌托西林／三唑巴坦、头孢哌酮／舒巴坦、头孢西丁耐药率较低，对其他抗菌药物均出现较高耐药。结论产ESBLS的大肠埃希菌和肺炎克雷伯菌分布在不同病区的不同标本中，碳青霉烯类抗生素亚胺培南和美罗培南是治疗产ESBLS菌株感染的较佳药物。

Objective To investigate the distribution and drug resistance of Escherichia coli and Klebsiella pneumoniae producing extended spectrum beta-lactamases （ESBLs） in hospital. Methods ESBLs was detected by CLSI/NCCLS phenotypic confirmatory test in E. coli（n 307） and K. pneumoniae（n：202） which were isolated from July 2004 to July 2006 in the hospital. Antimicrobial susceptibility was tested by Kirby-Bauer method. The distribution and drug resistance of strains producing ESBLs was analyzed. Results The detection rate of E. coli and K. pneurnoniae producing ESBLs was 38.4 % （118/307） and 31. 7 %（64/202）, respectively. The distribution of specimens mainly came from urine, sputum and respiratory secretions. The distribution of wards mainly came from pulmonary disease, neurosurgery, infectious, urology and ICU ward. The strains producing ESBLs were very susceptible to imipenem and meropenem, and relatively susceptible to piperacillin/tazobactam, cefoperazone/sulbaetam and cefoxitin. The resistance rate of the strains producing ESBLs was high to other antimierobial. Conclusion The E. coli and K. pneumoniae strains producing ESBLs distrib ute various kinds of specimens from different wards. Imipenem and meropenem of carbapenems could be better antimicrobial to treat the infection by strains producing ESBLs.