产超广谱β-内酰胺酶细菌的检出率和耐药性分析

Drug Resistance Analysis of ESBLs-producing Bacteria

目的了解近年来产超广谱β-内酰胺酶(ESBLs)细菌感染的发生率及耐药特征。方法对常熟市第二人民医院2003—2005年住院患者送检的各类标本中分离到的肺炎克雷伯菌和大肠埃希菌进行ESBLs检测。结果该院产ESBLs的肺炎克雷伯菌和大肠埃希菌检出率从2003年的38.98%和36.36%上升到2005年的55.56%和50.54%;产ESBLs菌与非产ESBLs菌对亚胺培南100%敏感;产ESBLs菌对其他13种抗菌药物的耐药率均高于非产ESBLs菌,其中阿米卡星的耐药率上升较慢,而其他抗菌药物耐药率上升较快,特别是所有第3代以上头孢类抗生素的耐药率上升趋势令人担忧。结论肺炎克雷伯菌和大肠埃希菌的ESBLs检出率与耐药率逐年增加,这与第3代以上头孢类抗生素使用率逐年增加有密切关系,抗菌药物的合理应用是控制和避免耐药菌株产生的关键所在;产ESBLs菌重症感染的患者应首选亚胺培南。

Objective To study the incidences and drug- resistance characteristics of ESBLs- producing bacteria in the past three years of the hospital, Methods The incidence of ESBLs- producing stains among clinical isolates of Escherichia call, Klebsiella pneumoniae from Jan. 2003 to Dec, 2005 was detected. Results The isolated ratio of ESBLs- producing Klebsiella pneumoniae and Escherichia coil increased from 38.98% and 36.36% to 55.56% and 50.54% respectively, All strains had 100% susceptibility to imipenem, Except for imipenem, ESBLs-producing strains had a higher resistance rate to other 13 kinds of antibiotics than ESBLs non-producing strains, The warring fact is that these ESBLs- producing strains showed all increasing resistance rate to most third or fouth- generation cefphalosporins although this resistance trend was relatively mild in amikacin. Conclusion There is an increasing trend of ESBLs- producing Klebsiella pneumoniae and Escherichia coli, which may be attributed to the overuse of third or fouth- generation cefphalosporins, It is important for clinicians to get well informed of the distribution and the resistance characteristics of ESBLs- producing strains in order to apply rational antibacterial treatment in these patients.