产超广谱β-内酰胺酶菌在儿童下呼吸道感染中的分布

Distribution of extended spectrum β-lactamases producing bacteria in children with respiratory tract infection

目的了解儿童细菌性急性下呼吸道感染(ALRTIs)产超广谱β-内酰胺酶(ESBLs)细菌的发生率、分布及耐药率。方法采用法国梅里埃ATB Expression鉴定及药敏仪,对2002年1月～2005年12月细菌性ALRTIs的住院患儿进行痰液细菌培养,对检出的大肠埃希菌、肺炎克雷伯菌作ESBLs表型筛选及确证试验,并用K-B纸片扩散法作常用抗生素体外试验。结果4年共检出细菌1433株,其中大肠埃希菌287株,产ESBLs124株(43.6%);肺炎克雷伯菌154株,产ESBLs 51株(33.1%)。小于1月龄患儿肺炎克雷伯菌产酶株明显高于1岁以上者,两组比较差异有统计学意义(χ2=3.97,P<0.05);ICU、新生儿病房的产酶株高于普通病房,但差异无统计学意义。结论产ESBLs细菌主要来自医院感染,强调医护人员勤洗手制度,隔离患者,有条件的医院应开展病原学及其耐药监测,动态了解当地及本院的细菌耐药状况,以指导临床合理使用抗生素。

objectives To study the distribution and prevalence of extended spectrum β-lactamases （ESBLs） producing bacteria and the incidence of drug-resistance in children with respiratory tract infection. Methods Drug sensitivity test, ESBLs phenotype screening and verification test on colibacillus and klebsiella of sputum culture from lower respiratory tract of children between January 2002 and December 2005 were performed. Normal slip diffusion, K-B method and in vitro test of drugs-reaction were investigated. The bacteriostatic circle greater than five milliliter （ ≥ 5 mm） to that treated by single ceftazidime was defined as ESBLs strain. Results Total 1 433 bacteria strains were detected in sputum culture from lower respiratory tract of children between January 2002 and December 2005. Among them, 287 were colibacillus with 124 （43.6%） producing ESBLs, 154 klebsiella with 51 （31%） producing ESBLs. The ESBLs producing bacteria were found more in children under 1 year old than those in children over 1 year old （Х^2 = 3.97, P 〈 0.05 ）. The ESBLs producing bacteria were also more prevalent in neonates ward and ICU than in other wards. Conclusions The ESBLs producing bacteria infection were more often due to iatrogenic cause. It is important for medical workers to take some measures against it. It is also necessary to make etiology diagnosis and drug-resistance test if it is possible. To know well about the situation of drug-resistance in local area and a hospital as well would be helpful to guide reasonable antibiotics use.