产ESBLs的大肠埃希菌和肺炎克雷伯菌的检测和耐药性分析

Detection of ESBL s produced by Escherichia coli and Klebsiella pneumonia and drug resistance monitoring

目的监测并分析我院2008—2010年间临床分离的大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）的情况及耐药性变化，为临床合理使用抗菌药物提供依据。方法对分离的大肠埃希菌和肺炎克雷伯菌采用VITEK2CMPACT的AST-13卡与K—β纸片扩散法相结合进行药敏试验，用筛选和确证试验确认产ESBLs菌株，用WHONET5．3软件进行数据分析。结果分离的2132株大肠埃希菌中，产ESBLs的有993株，占46．56％；1041株肺炎克雷伯菌中，产ESBLs的有438株，占41．98％。产ESBLs菌株的耐药性显著高于非产ESBLs菌株（P〈0．05），产ESBLs菌株呈多重耐药。结论三年来产ESBLs菌的检出率与耐药率呈总体平稳趋势，在抗感染治疗过程中，临床应根据药敏结果合理选择抗菌药物，特别是加强对产ESBLs菌株及其耐药性监测，以减缓细菌耐药性的产生。

Objective To monitor and analyze the circumstances of clinical isolates of Escheri- chia coli and Klebsiella pneumoniae producing ESBLs and the change of drug resistance between 2008 to 2010, to provide the evidence for clinical rational use of antimicrobial. Methods The susceptibility of the isolates of Escherichia coli and Klebsiella pneumoniae was detected by AST-βof VITEK 2 CMPACT combined with K-B disk diffusion, the ESBLs-producing strains were confirmed by screening and confirmatory tests, software WHONET 5.3 was used for data analysis. Results In 2132 strains of Escherichia coli, 993（46.56%） ESBLs-producing strains were 438（41.98%） confirmed. ESBLs-producing strains were confirmed out of 1041 Klebsiella pneumoniae strains. Drug resistance of the strains producing ESBLs was significantly higher than that of the non-producing ESBLs strains （P 〈 0.05）, ESBLs-producing strains were muti-drug resistant strains. Conclusion Detection rate and drug resistance of the strains producing ESBLs was appeared stable tendency. In anti-infection treatment process, the clinical should choose the antimicrobial reasonably based on the susceptibility results, especially strengthen the monitoring of ESBLsproducing strains and drug resistance, in order to reduce bacterial drug resistance.