超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的耐药性

Comparative study of antibiotic resistance in clinical isolates of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum beta lactamases

目的 了解超广谱 β 内酰胺酶 (ESBLs)肺炎克雷伯菌、大肠埃希菌的耐药性、耐药特点 ,指导用药。方法 对应用双纸片协同试验法检测 62株产ESBLs的肺炎克雷伯菌、大肠埃希菌的体外抗生素耐药性作了初步研究。结果 ESBLs总阳性率为 4 0 3 % ,以重症监护病房为最高 ( 75 0 % )。产ESBLs菌对头孢他啶、头孢噻肟、头孢曲松的耐药性高达 82 9%～ 10 0 0 % ,较不产ESBLs菌高 77 0 %～ 94 0 %。对氨基糖苷类、氟喹诺酮类、磺胺类的交叉耐药性最高分别达到 96 3 %、85 2 %、92 6% ,所有受试菌对亚胺培南均敏感。大肠埃希菌对阿米卡星耐药率较肺炎克雷伯菌低。结论 治疗ESBLs菌引起的感染 ,应用亚胺培南、头霉素类、含β 内酰胺酶抑制剂复合物及其药敏试验显示敏感的药物有效。

Objective To determine the prevalence of strains producing ESBLs among Klebsiella pneumoniae and Escherichia coli, and investigate the antibiotic resistance of these strains. Methods 62 strains of ESBLs producing E. coli and K. pneumoniae were determined by a double disk synergy test and antibiotic susceptibility test by Kirby Bauer test. Results The prevalence of ESBLs in isolates of 154 E. coli and K. pneumoniae was 40.3%, the resistance rate of ESBLs producing strains to ceftazidime, cefotaxime, ceftriaxone was 77.0%～94.0%, a higher than that of non ESBLs producing strains. ESBLs producing strains had higher resistance rate to aminoglycosides, quinolones, sulfonamides (96 3%, 85 2%, 92 6%, respectively). All tested strains However, were susceptible to imipenem. Conclusions To deal with the ESBLs producing strains, such antibiotics as imipenem, cefoxitin, β lactama/ β lactamase inhibitor combinations and others which are sensentive to such strains can be used.