医院与社区获得性肺炎患者大肠埃希菌的耐药性分析

Drug resistance of Escherichia coli causing hospital and community-acquired pneumonia

目的分析医院内获得性肺炎患者与社区获得性肺炎患者分离大肠埃希菌的耐药性及其耐药谱的变化,为临床预防感染以及合理用药提供依据。方法回顾性调查医院2008年6月-2011年12月获得性肺炎患者痰标本,对分离大肠埃希菌的药敏试验结果进行统计分析;并对医院获得性肺炎与社区肺部感染患者分离的病原菌及耐药性进行分析。结果从351份标本中分离出大肠埃希菌73株,分离率为20.80%,大肠埃希菌对亚胺培南的体外抗菌性最好,敏感率为100.00%;医院内获得性肺炎患者分离大肠埃希菌对阿米卡星、妥布霉素、哌拉西林/他唑巴坦的耐药率分别为45.65%、50.00%、26.09%,而社区获得性肺炎患者分离大肠埃希菌对阿米卡星、头孢吡肟、头孢他啶、妥布霉素的耐药率分别为7.41%、14.81%、22.22%、18.52%;医院内获得性肺炎患者分离大肠埃希菌产ESBLs检出率为73.91%,显著高于社区获得性肺炎患者的25.93%(P<0.01)。结论大肠埃希菌在肺炎患者中的分离率及耐药率较高,其中医院内获得性肺炎患者分离菌株的耐药性严重;对多药耐药菌的感染应以预防为主,建立耐药监控体系,加强耐药性监测,合理选用抗菌药物,以减少耐药菌株的出现。

OBJECTIVE To analyze the drug resistance and the change of drug resistance spectrum of Escherichia coli isolated from the patients with hospitals and community-acquired pneumonia so as to provide bases for clinical prevention of infection and rational use of antibiotics.METHODS The sputum samples obtained from the patients with acquired pneumonia from Jun 2008 to Dec 2011 were retrospectively investigated.Statistical analysis of the result of drug susceptibility testing was performed;the pathogens isolated from the patients with hospital-acquired pneumonia and the patients with community-acquired pneumonia as well as their drug resistance were analyzed.RESULTS There were 73 strains of E.coli which were isolated from 351 specimens with the isolation rate of 20.80%;the susceptibility rate of E.coli to imipenem was 100.00%;the resistance rates of E.coli isolated from the patients with hospital-acquired pneumonia to amikacin,tobramycin,and piperacillin-tazobactam were 45.65%,50.00%,and 26.09%,respectively;the resistance rates of E.coli isolated from the patients with community-acquired pneumonia to amikacin,cefepime,ceftazidime,and tobramycin were 7.41%,14.81%,22.22%,and 18.52%,respectively;the detection rate of ESBLs-producing E.coli from the patients with hospital-acquired pneumonia was 73.91%,significantly higher than 25.93% of which from the patients with community-acquired pneumonia（P0.01）.CONCLUSION Both the isolation rate and the drug resistance rate of E.coli isolated from the patients with pneumonia are relatively high,the drug resistance of the strains isolated from the patients with hospital-acquired infection is serious;in order to prevent the infections caused by multidrug-resistant bacteria,it is necessary to establish surveillance system for drug resistance,strengthen the surveillance of drug resistance,and reasonably use antibiotics so as to reduce the drug resistant strains.