ICU分离大肠埃希菌和肺炎克雷伯菌超光谱β-内酰胺酶的耐药性分析

The Incidence and Antibiotic-resistant Analysis of Escherichia Coli and Klebsiella Pneumoniae with Extended Spectrum β Lactamases Isolated From Intensive Care Unit

目的:研究重症监护病房(ICU)分离的大肠埃希菌(E.coli)和肺炎克雷伯菌(K.pneumoniae)超广谱β-内酰胺酶(ESBLs)的检出率和耐药情况,为临床合理选用抗生素提供依据。方法:按照CLSI推荐的K-B纸片法进行药敏试验,表型确证试验检测细菌ESBLs表型。结果:626株E.coli中检出产ESBLs菌457株,检出率为73.0%。484株K.pneumoniae中检出产ESBLs菌320株,检出率为66.0%。分离的细菌全部对亚胺培南(IPM)敏感,产ES-BLs菌株对加入酶抑制剂的哌拉西林-他唑巴坦(TZP)、头孢哌酮-舒巴坦(SCF)以及阿米卡星(AMK)、头孢西丁(FOX)的耐药率较低。E.coli和K.pneumoniae对头孢他啶(CAZ)的耐药率分别为21.7%和42.6%,其差异性具有统计学意义(P<0.01),对其它药物的耐药率均较高。结论:ICU分离的E.coli和K.pneumoniae耐药情况非常严重,应加强对ICU分离的E.coli和K.pneumoniae的耐药性监测。特别应注意严格控制第三代头孢菌素的使用,减少ESBLs的产生和扩散。

Objective To investigate the incidence and the status of antibiotic-resistance of Escherichia coli（E.coli） and Klebsiella pneumoniae（K.pneumoniae） with extra-broad spectrum beta-lactamase（ESBLs） isolated from intensive care unit（ICU） and thereafter provide a basis for selecting appropriate antibiotics in the clinical practice.Methods The antibiotic-sensitive tests were performed with K-B paper strip method recommended by CLSI.The bacteria with ESBLs was confirmed with phenotype test.Results There were 457 strains with ESBLs among 626 isolated E.coli strains from ICU,the incidence was 73%.There were 320 strains with ESBLs among 484 isolated KPN strains,the incidence was 66%.The isolated bacteria strains were all sensitive to IPM.The antibiotic-resistant incidence was comparatively low for the strains with ESBLs after treated with the ESBLs inhibitors such as TZP,SCF,AMK and FOX.There was a significant difference for E.coli and K.pneumoniae in the incidence of resistance to CAZ,being 21.7% and 42.6%,respectively.The incidence of resistance to other antibiotics of E.coli and K.pneumoniae with ESBLs was all very high.Conclusion The situation of drug-resistance for E.coli and K.pneumoniae isolated from ICU was severe,It should be suggested that emphasis be paced on the monitoring of resistance to antibiotics E.coli and K.pneumoniae isolated from ICU.The administration of the third generation of cephalosporin should be strictly controlled to reduce the occurrence and spread of the bacteria strains with ESBLs.