胆道感染大肠埃希菌与肺炎克雷伯菌的耐药性分析

Drug resistance of Escherichia coli and Klebsiella pneumoniae in biliary tract infections

目的对胆道感染大肠埃希菌（ECO）和肺炎克雷伯菌（KPN）的耐药性进行调查分析,为合理使用抗菌药物提供依据。方法共78株ECO和36株KPN,均来自医院2007-2009年接受胆道手术患者的胆汁标本,采用K-B法测定12种常用抗菌药物的敏感性,用纸片协同法检测超广谱β-内酰胺酶（ESBLs）。结果胆道感染ECO和KPN的耐药性普遍较高,对第二-四代头孢菌素耐药率,ECO在53.8%-65.4%,KPN则在47.2%-61.1%;磺胺甲噁唑/甲氧苄啶耐药率分别为70.5%和72.2%,环丙沙星分别为57.7%和47.2%;所有菌株对碳青霉烯类全部敏感,对含酶抑制剂复合药和阿米卡星的耐药率也较低;ESBLs检出率ECO为43.6%,KPN为41.7%。结论 ECO和KPN是胆道感染的主要病原菌,术前过早、过多使用广谱抗菌药物是产酶菌株增多和耐药性增强的主要原因。

OBJECTIVE To investigate the drug resistance of Escherichia coli（ECO） and Klebsiella pneumoniae（KPN） in biliary tract infections for the guidance of clinical reasonable use of antibiotics.METHODS A total of 78 ECO and 36 KPN were collected from 2007 to 2009.12 common antibiotics were tested by Disk diffusion test（Kirby-Baner） method and double disk synergy test was conducted to detect extended spectrum β-lactamases（ESBLs）.RESULTS ECO and KPN isolates had high resistant rate to antibiotic drugs,the resistant rate of which to Ⅱ Ⅲ and Ⅳ generation cephalosporin were 53.8%～65.4% and 47.2%～61.1%,to trimethoprim/sulfa were 70.5% and 72.2%,to ciprofloxacin were 57.7% and 47.2%.But carbapenem was sensitive to all of those strains.The drugs containing enzyme inhibitor and amikacin both had higer sensitive rate to them.The detection of ESBLs in ECO was 43.6% and in Klebsiella pneumoniae was 41.7%.CONCLUSION ECO and KPN are the main pathogens of biliary infections.Antibiotic drugs abuse before operation is one reason that causes the increase of enzyme-producing strains and the intensity of drug resistance.