临床可疑产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性分析

Antibiotic resistance of extended spectrum β-lactamases (ESBLs)-producing escherichia coli and klebsiella pneumoniae in clinical dubious isolates

目的了解可疑产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的构成比和耐药情况,指导临床合理用药。方法对2008年7～12月住院患者各种临床标本,采用美国临床实验室标准化委员会推荐的表型筛选法分离到可疑产ESBLs大肠埃希菌和肺炎克雷伯菌,再经确认试验检测产ESBLs菌株,统计耐药分布情况。结果从248株阳性标本中共检出可疑产ESBLs菌株117株,其中大肠埃希菌38株,肺炎克雷伯菌79株;确证试验检测出产ESBLs菌82株,总检出率为33.1%,其中大肠埃希菌27株,肺炎克雷伯菌55株。确定为产ES-BLs的菌株对氨苄西林、部分第3代头孢菌素的耐药率为100.0%,对磺胺类、喹诺酮类耐药率为60.0%～90.0%,对亚胺培南的耐药率为0.0%。结论产ESBLs的大肠埃希菌和肺炎克雷伯菌对多种抗菌药物的耐药率明显高于非产ESBLs菌株,具有多重耐药性;而碳青霉烯类亚胺培南仍然是对产ESBLs细菌最有效的药物。

Objective To study the characteristic about antibiotic resistance of extended- spectrum β-lactamases（ESBLs）-producing Escherichia coli（E, cold and Klebsiella pneumoniae （K. pneumoniae） for guiding the clinical drug using. Methods The ESBLs produving dubious E. coli and K. pneumoniae were isolated form all sorts of specimens from July 2008 to Dec. 2008 by the method recommended by the National Committee for Clinical Laboratory Standard （NCCLS）,and then detect the ESBLs through the confirmatory test. Results Among 248 strains ,there were 117 strains of E. coli and K. pneumoniae belonging to suspected ESBLs-producing strains, and 82 were con： firmed ESBLs producing strains,with the positive ratio being 33.1%. All of the ESBLs-producing strains were resistant to penicillins,with the rate of resist to some of the 3rd ceph-alosporin being 100. 0%, the rate of resist to sulfonamides and quinolones being 60.0%-90. 0% ,and imipenem being 0.0%. Conclusion The resistant rate of the ESBLs-producing E. coli and K. pneumoniae had better activity than that of non ESBLs to antimicrobial; the sensitive rate of the ESBLs-producing strains to aminoglycoside was relatively high. So imipenem is the best drug for the ESBLs-producing strain.