2000-2008年江汉平原地区产超广谱β-内酰胺酶肠杆菌科流行率及耐药性变迁

Change in Distribution and Drug Resistance of Extended-spectrum β-Lactamases-producing Enterobacteriaceae in Jianghan Plain of China 2000-2008

目的调查临床分离的产超广谱β-内酰胺酶肠杆菌科流行率及其耐药性变化趋势。方法对江汉平原4所大中型医院2000-2008年分离的肠杆菌科细菌资料进行分析,统计其中产超广谱β-内酰胺酶细菌分离率及耐药性变化,使用K-B法进行药敏试验,纸片扩散表型确证法进行检测超广谱β-内酰胺酶(ESBLs)检测。结果临床分离的肠杆菌科细菌8928株中共分离出产ESBLs菌株3817株,产ESBLs肠杆菌科细菌分离率从2000年的17.34%增加到2008年的67.03%,检出率上升明显;产ESBLs肠杆菌科主要为大肠埃希菌和肺炎克雷伯菌,分别占产ESBLs肠杆菌科66.34%和27.67%;菌株检出来源主要尿液和痰标本;除碳青酶烯类抗菌药物外,产ESBLs菌对其他类抗菌药物均不同程度耐药且耐药性上升趋势明显;产ESBLs大肠埃希菌和肺炎克雷伯菌对青霉素类如氨苄西林、哌拉西林耐药率均>95.0%,对氨苄西林/舒巴坦耐药率高达83.8%和75.5%;对氨基糖苷类、喹诺酮类药物耐药率分别为42.7%～66.6%,对碳青酶烯类药物亚胺培南、美罗培南敏感率仍>98.0%。结论产ESBLs细菌检出率及耐药率近年大幅上升,应高度重视ESBLs检测,控制其传播和流行。

OBJECTIVE To investigate the trend of distribution and antimicrobial agents resistance of extended-spectrum β-lactamases（ESBLs）-producting Enterobacteriaceae in Jianghan Plain.METHODS To analyze the data collected from 4 hospitals in Jianghan Plain from 2000 to 2008.The ESBLs-producing strains were detected by diffusion confirmed method and the antibiotics susceptibility test was performed by Kirby-Bauer disk diffusion method.RESULTS A total of 8928 strains of Enterobacteriaceae were identified and of them 3817 isolates were ESBLs-producing strains,which increased from 17.34% to 67.03% from 2000 to 2008,the prevalent ESBLs strains were Klebsiella pneumoniae and Escherichia coli（66.34% and 27.67%,respectively）.The resistance rate of ESBLs-producing E.coli and K.pneumoniae strains mostly increased obviously except to carbopenems.The resistance rate to gentamicin,ofloxacin and levofloxacin was 42.7-66.6%;Carbopenems e.g.imipenem and meropenem remained with high activity against ESBLs-producing Enterobacteriaceae（〉98%）.CONCLUSION The detected rate of ESBLs-producing Enterobacteriaceae increases obviously.Clinicians should pay attention importance to the ESBLs detecting to aviod the spread of the ESBLs-producting bacteria.