医院产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的检测及耐药性

Detection and drug-resistance analysis of ESBLs producing Klebsiella pneumonia and Escherichia coli

目的:了解我院产超广谱β-内酰胺酶(extended spectrum β-lactamase,ESBLs)肺炎克雷伯菌和大肠埃希菌的检出率及其耐药特征,为临床合理使用抗生素提供依据。方法:对我院2003年1月～2005年12月住院病人分离的肺炎克雷伯菌122株、大肠埃希菌313株,采用NCCLs推荐的纸片扩散表型确证试验进行ESBLs检测,用K-B法做药敏试验。结果:435株肺炎克雷伯菌和大肠埃希菌中检出产ESBLs菌139株,总检出率31.95%,其中肺炎克雷伯菌检出率33.61%、大肠埃希菌检出率31.31%;ESBLs检出率有逐年上升趋势;呼吸道标本ESBLs检出率最高,占59.71%;产ESBLs菌对抗生素的耐药率显著高于不产ESBLs菌(P<0.005),并对氨基糖苷类、喹诺酮类等抗生素呈多重耐药,对含β-内酰胺酶抑制剂的复合抗生素耐药率有增高趋势,均对亚胺培南敏感。结论:肺炎克雷伯菌和大肠埃希菌的ESBLs检出率逐年增加,应及时对ESBLs菌进行检测,以指导临床用药。亚胺培南可作为ESBLs菌治疗的首选药。

Objective：To investigate the producing rate and the characteristics about drug-resistance of extended-spectrum β-lactamases （ESBLs） producing KlebsieUapneumonia and Escherichia coli in our hospital for the guidance on the rational usage of antibacterial. Methods：122 strains of Klebsiella pneumonia and 313 strains of Escherichia coli collected from clinical samples during January 2003 to December 2005 were tested by Phenotypic Confirmatory Test and confirmed by the method advised by NCCLs and drug-sensitivity was tested with K-B. Results：Among the isolated 435 samples, 139 strains were considered ESBLs-producing bacteria （31.95%）, with 33.61% of Klebsiella pneumonia and 31.3% of Escherichia coli respectively; the rate of ESBLs producing has a tendency of increasing every year, with the specimens of respiratory system having the highest 59.71%. Antibiotic resistance when compared to non-producing strains, the rates of the producing ones with ESBLs in all isolates were significantly higher than those of ESBLs non-producing strains （P〈 0.005）. The antibiotic resistance of the producing strains was observed against aminoglycosides and quinolones, etc. The producing strains showed an increasing antibiotic resistance against the complex antibiotics containing β-lactamases inhibitor. All the strains showed their sensitivity to imipenem. Conclusion：In view of the increasing rate of ESBLs-producing Kebsiella pneumonia and Escherichia coli every year, it is necessary to detect and supervise ESBLs in time for the guidance of clinical usage. Imipenem is the first choice in treating infections caused by ESBLs-producing strains.