大肠埃希菌与肺炎克雷伯菌烧伤创面分离株的耐药性分析

Antibiotic resistance of Escherichia coliand Klebsiella pneumoniae isolated from burn wounds

目的了解烧伤创面大肠埃希菌和肺炎克雷伯菌感染株的耐药性。方法药敏试验采用K-B法,ESBLs检测采用纸片协同确证法。结果 158株大肠埃希菌共检出产ESBLs菌51株,检出率为32.3%;53株肺炎克雷伯菌共检出产ESBLs菌21株,检出率为39.6%;大肠埃希菌和肺炎克雷伯菌的药敏结果相仿,对氨苄西林和磺胺甲恶唑/甲氧苄啶耐药率高达75.3%～83.0%,喹诺酮类药物耐药率为41.5%～47.2%,三代头孢耐药率为39.9%～50.9%;未发现亚胺培南和美罗培南耐药株,头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率处较低水平;产酶株的耐药率高于非产酶株。结论烧伤创面感染的大肠埃希菌和肺炎克雷伯菌耐药率严重,临床应提高标本送检率,根据细菌培养、药敏试验和ESBLs检测的结果,合理选用或调整治疗用药,控制耐药菌的产生和播散。

OBJECTIVE To study the drug resistance of Escherichia coli（ECO） and Klebsiella pneumoniae（KPN） isolated from burn wounds.METHODS The K-B method and paper synergy test were adopted to perform drug susceptibility testing and the detection of ESBLs,respectively.RESULTS Of 158 ECO isolates,totally 51 ESBLs-producing isolates were detected with the detection rate of 32.3%,and 21 ESBLs-producing isolates were detected from 53 KPN isolates with the detection rate of 39.6%;the drug susceptibility testing showed that ECO and KPN had similar drug susceptibility.The resistance rates to ampicillin and sulfamethoxazole/trimethoprim reached to 75.3%-83.0%,the resistance rate to quinolones was 41.5%-47.2%,and the resistance rate to the third generation of cephalosporine was 39.9%-50.9%;no imipenem and meropenem-resistant isolate was found.The resistance rates to cefoperazone/sulbactam and piperacillin/tazobactam were at a low level,and the drug resistance rate of ESBLs-producing strains was higher than that of non-ESBLs-producing strains.CONCLUSION The drug resistance of ECO and KPN isolated from burn wounds is serious.Clinicians should improve the specimens submission rate,select and adjust antibiotics for therapy according to the results of bacterial culture,drug susceptibility test and ESBLs detection to control emergence and spread of resistant isolates.