肺部感染革兰阴性杆菌产超广谱β-内酰胺酶的耐药性分析

Detection of Extended-spectrum Beta-lactamases and Analysis of Antibiotics Resistance of Clinical Isolates from Pneumonia Patients

目的了解下呼吸道感染社区获得性肺炎与医院获得性肺炎感染革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)的情况及其对常用抗菌药物的耐药性分析。方法收集医院2005年5月-2006年12月自痰标本中分离出的革兰阴性杆菌,采用标准纸片扩散法检测ESBLs,采用K-B纸片扩散法进行药物敏感检测,试验数据处理使用χ2检验。结果社区获得性肺炎感染革兰阴性杆菌产ESBLs的阳性率为13.3%,医院获得性肺炎感染革兰阴性杆菌产ESBLs阳性率为28.37%,社区获得性肺炎感染革兰阴性杆菌产ESBLs的阳性率显著低于医院感染(P<0.05);社区获得性肺炎与医院获得性肺炎中分离革兰阴性杆菌对亚胺培南的耐药率分别为2.18%和3.54%,两者相比差异无统计学意义(P>0.05);社区获得性肺炎感染革兰阴性杆菌产ESBLs菌株除庆大霉素外,对其他抗菌药物耐药率与医院获得性肺炎感染菌株耐药率差异无统计学意义(P>0.05);两者感染革兰阴性杆菌非产ESBLs菌株除亚胺培南、氨苄西林外,对其他11种抗菌药物相比差异有统计学意义(P<0.05)。结论医院获得性肺炎感染革兰阴性杆菌产ESBLs率显著高于社区获得性肺炎感染株,尤以ICU显著,应加强抗菌药物的管理及病原菌的检测,规范经验性抗菌药物治疗。

OBJECTIVE To analyze the productive rates of extended-spectrum beta-lactamases （ESBLs） in the clinical isolates of Gram-negative bacteria from commuity-acquired pneumonia （CAP） and hospital-acquired pneumonia（HAP） patients, and investigate their resistance to 13 kinds of antibiotics. METHODS ESBLs were detected by the double disc diffusion method and the antibiotics susceptibility test was performed by Kirby-Bauer disk diffusion method. The X^2 test was used to analyze the results. RESULTS The productive rate of ESBLs detected among CAP patients was 13.1%. The productive total rate of ESBLs detected among HAP patients was 28.36%. The former was significantly lower than the latter （X^2 test, P〈0.05）. The resistance rates of community-acquired and hospital-acquired strains to imipenem were 2. 18% and 3. 54%, respectively, there was no significant difference between them （X^2 test,P〉0.05）. Except gentamicin, there were no significant difference between the resistance of ESBLs-producing strains from CAP and from HAP to other eleven kinds of antibiotics （X^2 test, P〉0.05）. Except imipenem and ampicillin, there was significant difference between the resistance of non-ESBLs-producing strains from CAP and from HAP to other eleven kinds of antibiotics（X^2 test, P〈0.05）. CONCLUSIONS The productive total rate of ESBLs detected from HAP patients is significantly higher than that of from CAP patients. The supervision towards antibiotics must be strengthened to explore appropriate empirical therapy.