重症监护病房产ESBLs、p-AmpC酶和SSBL肺炎克雷伯菌检出率及耐药性研究

Study on drug resistance and detection rate of ESBLs,p-AmpC,SSBL producing klebsiella peumoniae

目的:研究重症监护病房(ICU)产超广谱β-内酰胺酶(ESBLs)、质粒型头孢菌素酶(p-AmpC)和SSBL(SSBL)肺炎克雷伯菌的检出率、耐药表型。方法:收集肺炎克雷伯菌368株,双纸片增效法检测ESBLs、三维试验检测p-AmpC,K-B纸片法进行药敏实验,WHONET5.4软件进行统计分析。结果:368株肺炎克雷伯菌中ESBLs阳性233株,检出率为63.3%;p-AmpC酶阳性67株,检出率为18.2%;SSBL阳性18株,为4.9%。检出率有逐年升高的趋势。产酶株的耐药率比不产酶株有不同程度增加,亚胺培南对所有产酶株都敏感。结论:对ESBLs、p-AmpC酶和SSBL的检测及其耐药监测,可以指导临床合理使用抗生素,减缓细菌耐药。

Objective： To investigate the detection rate,epidemiological data and drug-resistance of ESBLs, p-AmpC and SSBL producers in ICU. Methods.. 368 clinical isolates of Klebsiella peumoniae were collected from ICU. ESBLs producers were identified by phenotype affirmative test according to the guidelines of the Clinical and Laboratory Standards Institute in 2008,p-AmpC was identified by three diamensions test, respectively. Their resistances were performed by Kirby-Bauer test. Results： The incidences of ESBLs , p-AmpC and SSBL in Klebsiella peumoniae were 63. 3 percent, 18. 2 percent and 4. 9 percent respectively. Compared with the resistance rates in non-enzyme producing, those in enzyme producers to ceftazidime, piperacillinl/tazobaetam, amikaein and ciprofloxaein etc. increased. However, all enzyme producers were susceptible to imipenem. Conclusion：Monitoring of ESBLs , p-AmpC and SSBL producing strains and the drugresistance can contribute to guide the clinically reasonable use of antibiotics.