2006～2008年产超广谱β-内酰胺酶菌株的分离及药敏变化分析

目的了解2006～2008年临床产超广谱β-内酰胺酶(ESBLs)大肠埃希氏菌和肺炎克雷伯氏菌的分离及药敏变化情况,供临床参考。方法采用Microscan WalkAway全自动细菌分析仪进行分析与药敏试验,用K-B纸片药敏法和ESBLs检测条做补充,得到结果进行统计分析。结果这三年大肠埃希氏菌和肺炎克雷伯氏菌产ESBLs菌株的检出率分别平均是53.2%和45.5%三年内变化不明显(P>0.05),大肠埃希氏菌对阿米卡星敏感率由84.3%上升到89.6%,对特治星由83.2%上升到89.5%,对头孢他啶由74.2%上升至77.3%。阿莫西林/克拉维酸由84.9%降到69.8%,敏感率最低是氨苄西林和哌拉西林,敏感率15.6%以下,其次是环丙沙星和复方新诺明,敏感率32.2%以下,其他抗生素如头孢曲松、庆大霉素等11种这三年来变化不大(P>0.05)。肺炎克雷伯菌对阿莫西林/克拉维酸敏感率由80.1%降到69.5%,对阿林卡星由80.1%上升到85.5%,特治星由76.2%上升到84.8%,敏感率最低是氨苄西林3.6%以下,其他如头孢类,庆大霉素等14种抗生素敏感率不高,相对也较平稳(P>0.05),大肠埃希氏菌和肺炎克雷伯氏菌对亚胺培南培已出现不敏感菌株。结论大肠埃希氏菌和肺炎克雷伯氏菌产ESBLs菌株的检出率高,对各种抗生素呈多重耐药,应加强抗生素使用管理,合理用药。

Objective To investigate the distribution and drug resistance of extended-spectrum β-1acta- mases （ESBLs） -produing Escherichia eoli （ E. coli ） and Klebsiella pneumoniae （ K. pneumoniae） isolated in the third hospital of Zhongshan university, providing reference for clinical practice. Methods Microorganism identification and drug resistance analysis were achieved by the use of the Microscan WalkAway system, K-B method was used as a complement. ESBLs strip was used for the detection of ESBLs. Results The prevalence rate of ESBLs-produing E. coli and K. pneumoniae is 53.2% and 45.5% respectively, with non-significant change during the three years. The susceptibility of E. coli to Amikacin increased from 84. 3% to 89. 6%, to Piperacillin/ Tazobactam increased from 83.2% to 89.5% , to Ceftazidime increased from 74. 2% to 77.3%, however, to Amoxicillin/ClavulaniC Acid decreased from 84. 9% to 69.8%, to both Ampicilin and Piperacillin decrease to less than 15.6%, to both Ciprofloxacin and Trimethoprim/Sulfamethoxazole decreased to less than 32. 2% , to other 11 antibiotics demonstrated non-significant change. The susceptibility of K. pneumoniae to Amikacin increased from 80. 1% to 85.5% , to Amoxicillin/ClavulaniC Acid decreased from 80. 1% to 69. 5%, to Piperacillin/Tazobactam increased from 76. 2% to 84. 8%, however, to Ampicilin decreased to less than 3.6%, to other 14 antibiotics remains at low levels and demonstrated non-significant change. E. coli and K. pneumoniae strains resistant to Imipenem were isolated. Conclusion ESBLs-produing E. coli and K. pneumoniae strains is increasing, and usually multidrug resistant, requiring strict control on the use of antibiotics.