大肠埃希菌与肺炎克雷伯菌超广谱β-内酰胺酶的临床分布及药敏性分析

Extended-spectrum β-Lactamases-producing Klebsiella pneumoniae and Escherichia coli: Clinical Distribution and Antibiotic Resistance

目的了解大肠埃希菌与肺炎克雷伯菌超广谱β-内酰胺酶(ESBLs)的临床分布及耐药性。方法菌株鉴定采用法国生物梅里埃公司的VITEK-60分析仪,药敏试验采用K-B法,纸片扩散确证试验检测ESBLs。结果大肠埃希菌中ESBLs菌株占52.8%,肺炎克雷伯菌中ESBLs占63.5%;大肠埃希菌主要分离于尿液,占22.1%,其次是脓液/创面,占11.7%;主要来源于儿科和外科病区;肺炎克雷伯菌在痰及咽拭子中检测率最高,为37.8%;来源于新生儿病区为21.8%,小儿ICU为16.0%。结论治疗由ESBLs的大肠埃希菌和肺炎克雷伯菌引起的感染首选亚胺培南,次选哌拉西林/他唑巴坦。

OBJECTIVE To study the clinical distribution and the drug resistance of extended-spectrum β-lactamases （ESBLs） producing Klebsiella pneumoniae and Escherichia coli. METHODS The clinical isolates were identified by VITEK-60 of Bio-Merieux of France. K-B agar diffusion method and confirmed test were used to detect the drug resistance of ESBLs-producing K. pneumoniae and E. coli. RESULTS The incidence of ESBLs was 52.8% in E. coli and 63. 5% in K. pneumoniae. E. coli was mostly isolated from urine （22. 1%）. The second was isolated from pus/wound （11.7%）. Majority strains were isolated from surgical and pediatric wards. K. pneumoniae was mostly isolated from sputum and throat swab （37. 8%, 21.8% from neonate ward and 16% from child ICU. CONCLUSIONS To cure infections caused by ESBLs-producing K. pneumoniae and E. coli, imipenem is the best choice and piperacillin/tazobactam is the second choice.