肺炎克雷伯氏菌产超广谱β-内酰胺酶的检测及其耐药性研究

Detection and Drug-Resistance Analysis of Extended-Spectrum β-Lactmases-Producing Klebsiella Pneumoniae

目的:了解四川省泸州市地区肺炎克雷伯氏菌产超广谱β-内酰胺酶(ESBLs)情况及产ESBLs菌株的耐药性及耐药特点。方法:按NCCLS规定的初筛及表型确认试验检测是否产ESBLs,用K-B法作药敏试验。结果:确认有28株产ESBLs,占总数的35.4%;产ESBLs菌对氨苄西林/舒巴坦、环丙沙星、氨曲南、头孢泊肟、头孢曲松、头孢噻肟、头孢唑啉、哌拉西林的耐药率与非产ESBLs菌相比差异有统计学意义(P<0.01);产ESBLs菌对头孢吡肟、头孢他啶的耐药率与非产ESBLs菌相比差异有统计学意义(P<0.05);对哌拉西林/三唑巴坦、头孢西丁的耐药率与非产ESBLs菌相比差异无统计学意义(P>0.05);产ESBLs与非产ESBLs菌对亚胺培南全部敏感。结论:本地区肺炎克雷伯氏菌产ESBLs菌株流行严重;产ESBLs菌对常用抗生素的体外抗菌活性明显高于非产ESBLs细菌,对青霉素类、大部分第三代头孢菌素类抗生素耐药率很高,对喹诺酮类及氨基糖苷类耐药率也较高;相当部分对第四代头孢菌素敏感,大部分对头霉素类、β-内酰胺酶抑制剂复合制剂敏感;对碳青霉烯类高度敏感。

Objective： To investigate the productive rates and antibiotic resistance characteristics of extended -spectrum β- lactamases（ESBLs） - producing Klebsiella Pneumoniae isolated from clinical strains. Methods： ESBLs - producing strains were determined by disk diffusion screening test and confirmatory test of NCCLS ; Antibiotic susceptibility test were performed by Kerby- Bauer disk diffusion method. Results： 28 ESBLs- producing strains were determinded in confirmatory test, the rate of ESBLs production was 35.4 % ;The resistant rates of ESBLs- producing strains to 11 kinds of antibiotics were higher than those of non - ESBLs - producing strains, there were differences between the resistant rates of ESBLs - producing strains and those of non - ESBLs - producing strains （ P 〈 0.05）. There were not differences between the resistant rates of ESBLs - producing strains to 4 kinds of antibiotics and those of non - ESBLs - producing strains （P 〉 0.05）. The resistant rates of ESBLs- producing strains and non- ESBLs- producing strains to imipenem were 100 %. Conclusions： The situation of ESBLs- producing K - Pneumoniae is severe in this area; In most of antibiotics above, the resistant rates of ESBLs - producing K＇ Pneumoniae are significantly higher than those of non - producing - ESBLs. Imipenem, Cephamycins and β- laetamases inhibitor combinations can be used to deal with ESBLs - producing K .Pneumoniae infetion.