大肠埃希菌产超广谱β-内酰胺酶的监测及危险因素分析

Surveillance of ESBLs producing in Escherichia coli and analysis of risk factors

目的调查医院大肠埃希菌感染的临床分布、耐药性及患者感染产超广谱β-内酰胺酶(ESBLs)菌的危险因素,为临床合理使用抗菌药物提供科学依据。方法采用法国生物梅里埃公司ATB细菌鉴定仪对产ES-BLs菌进行检测,药敏试验用K-B纸片法,根据2005年美国临床实验室标准化委员会标准判断结果,应用WHO-NET5软件对临床分离细菌的药敏结果进行数据统计分析。结果确证87株产ESBLs菌,产酶率为31.5%;不同标本种类中产ESBLs菌检出情况分别为尿液35株(40.2%),痰液23株(26.4%),血液7株(8.0%);各病区产ES-BLs菌的分离率以重症监护病房(ICU)最高(47.1%),其次为烧伤病房(40.0%),泌尿外科病房(34.2%);产ES-BLs大肠埃希菌的耐药率明显高于非产ESBLs大肠埃希菌;感染产ESBLs菌危险因素为长期使用三代头孢菌素、入住ICU患者。结论该院大肠埃希菌产ESBLs菌尚未有效控制,仍然处于较高水平;治疗大肠埃希菌感染时,需根据药敏结果及患者病情选用碳青霉烯类、氨基糖苷类、β-内酰胺类抗生素/β-内酰胺酶抑制剂等。

Objective To investigate the clinical distribution,drug resistance and risk factor of Escherichia coli（E.coli） infection so as to provide the scientific basis for reasonable clinical use of antibacterials.Methods To detect ESBLs-producing bacteria by ATB microbiological system.The Kirby-Bauer（K-B） test was adopted for the drug susceptibility test.The results were evaluated based on the National Committee for Clinical Laboratory Standards（NCCLS） of USA in 2005.The data were analyzed by using WHONET-5 software.Results 87 strains of ESBLs-producing bacteria were detected and the isolated rate was 31.5%.Among different samples,35 strains（40.2%） of ESBLs-producing bacteria were isolated from urine samples,23 strains（26.4%） from sputum,and 7 strains（8.0%） from blood.The isolated rate of ESBLs-producing bacteria was highest in ICU（47.1%）,the second was in the burn wards（40.0%） and the urology wards（34.2%）.The resistant rates of ESBLs-producing strains were significantly higher than that non ESBLs-producing E.coli.The risk factors for infection of ESBLs-producing bacteria were the long-period use of the third-generation of cephalosporins and admission to ICU.Conclusion ESBLs-producing E.coli isolated in our hospital have not been effectively controlled and are still in high level.In treating E.coli infection,carbopenems,aminoglycosides,β-lactam/β-lactamase inhibitor should be selected according to the results of drug sensitivity tests and disease condition.