产超广谱β-内酰胺酶革兰阴性杆菌的检测和耐药性研究

Detection of ESBL-producing clinical isolates of gram negative bacilli and their antibiotic resistance in Shantou

目的 研究汕头地区革兰阴性杆菌产超广谱β-内酰胺酶（ESBLs）情况及其耐药特性,为临床合理使用抗生素提供依据.方法 收集汕头地区革兰阴性杆菌共1 445株（大肠埃希菌895株和肺炎克雷伯菌550株）,采用Vitek-2全自动细菌鉴定和药敏分析仪进行ESBL检测和药敏实验.结果 69.4%大肠埃希菌和33.6%肺炎克雷伯菌产ESBLs.产ESBLs菌株对青霉素类、头孢菌素类和单环类抗生素的耐药率极高 产ESBLs菌株存在多重耐药性,而且对多种抗生素的耐药率明显比不产ESBLs菌株高 产ESBLs菌株和不产ESBLs菌株对亚胺培南均未出现耐药.结论 汕头地区革兰阴性杆菌中ESBLs菌株检出率高 产ESBLs菌株耐药性比不产ESBLs菌株高,且耐药表型多样性 亚胺培南是临床治疗产ESBLs菌株感染的首选药物.

Objective To investigate the extended-spectrum beta-lactamases （ ESBLs） producing clinical isolates of gram negative bacilli and their antibiotic resistance in Shantou and to provide suggestions on empirical treatment against the bacteria.Methods A total of 1 445 strains of gram negative bacilli （895 strains of Escherichia coli and 550 strains of Klebsiella pneumonia） were collected and examined for the production of ESBLs and antibacterial susceptibility test by Vitek-2.Results There were 69.4% of escherichia coli and 33.6% of klebsiella pneumonia producing ESBLs.The resistance rate of the ESBLs-producing strains to penicillins,cephalosporins and monocyclic beta-lactam antibiotics were very high.The ESBLs-producing strains were multidrug resistant and the resistance rates were higher than that of the non-ESBLs-producing strains.Both ESBLs-producing and non-ESBLs-producing strains were susceptible to Imipenem.Conclusion The incidence of ESBLs-producing strains was high in gram negative bacilli in Shantou.The resistance rates of the ESBLs-producing strains were higher than that of the non-ESBLs-producing strains and they expressed multiple drug resistance phenotypes.Imipenem was the best drug in the treatment of infections caused by ESBLs-producing strains.