大肠埃希菌及肺炎克雷伯杆菌血流感染分布及药敏分析

Distribution and antibiotic sensitivity of Escherichia coli and Klebsiella pneumoniae in bloodstream infections

目的回顾性分析大肠埃希菌和肺炎克雷伯杆菌血流感染临床分布及药敏特征。方法收集71例次大肠埃希菌及21例次肺炎克雷伯杆菌血流感染患者的年龄、性别、入住科室、基础疾病及其药敏结果资料。药敏试验采用Kirby-Bauer法。结果急性白血病是高发基础疾病。大肠埃希菌及肺炎克雷伯杆菌产超广谱β-内酰胺酶(ESBLs)阳性率分别为67.6%和42.8%。近3年中,肺炎克雷伯杆菌产ESBLs的比例有上升趋势,产ESBLs菌对除亚胺培南、丁胺卡那霉素外的其它常用抗菌药物敏感率均明显低于非产ESBLs菌(P<0.05)。结论血流感染中,大肠埃希菌、肺炎克雷伯杆菌产ESBLs率高,产酶菌对多种常用抗菌药物高度耐药,亚胺培南仍是经验治疗的首选药物。

Objective To analyze the distribution and antibiotic sensitivity of Escherichia coli and Klebsiella pneumoniae in bloodstream infections. Methods Clinic data of 71 Escherichia coli and 21 Klebsiella pneumoniae bloodstream infections in the First Affiliated Hospital of Soochow University during January 2007 to December 2009 were collected. The age, sex, clinical department, underlying diseases,bacterial strains, antibiotic sensitivity of those patients were＇analyzed. Antibiotic sensitivity was detected with Kirby Bauer method. Results Acute leukemia was the most common underlying disease of bloodstream infection. The proportions of producing extended spectrum lactamases （ESBLs） in Escherichia coli and Klebsiella pneumoniae were 67.6% and 42.8%, respectively. During the past three years, there was an increased tedency of Klebsiella pneumoniae producing ESBLs. The sensitivity to common antibiotics, except for imipenem and amikacin, of bacteria producing ESBLs was less than that producing non-ESBLs （P〈0. 05）. Conclusion The rate of producing ESBLs is high in Escherichia coli and Klebsiella pneumoniae bloodstream infections. Bacteria strains producing ESBLs showe high resistant to many common antibiotics. Imipenem is still the first choice for empirical treatment.