产ESBL大肠埃希菌和肺炎克雷伯菌的临床分布及耐药性特点

Clinical distribution of ESBL-producing E.coli and K.pneumoniae and analysis of drug resistance

目的了解某综合医院产ESBL大肠埃希菌(ESBL-EC)和肺炎克雷伯菌(ESBL-KP)耐药性的变迁。方法分析该医院2010-2011年临床微生物室上报医院感染控制科ESBL-EC及ESBL-KP对常用抗菌药物的耐药性变迁数据。结果碳青霉烯类亚胺培南-西司他丁对ESBL-EC及ESBL-KP保持完全敏感,头孢西丁及阿米卡星对ESBL-EC及ESBL-KP均有良好的敏感性(>80%),头孢他啶及头孢吡肟耐药率逐年下降,但ESBL-EC及ESBL-KP对大多数β-内酰胺类药(氨苄西林,哌拉西林,替卡西林,头孢唑林,头孢曲松,头孢噻肟,头孢哌酮)完全耐药。含酶抑制剂对ESBL-EC保持了较优的敏感率(>92%),对ESBL-KP敏感性则降低(头孢哌酮/舒巴坦和哌拉西林/他唑巴坦敏感率分别介于50%～89%与67%～92%之间)。左氧氟沙星的耐药率维持在高位(对ESBL-EC耐药率介于57%～81%之间,对ESBL-KP耐药率介于16%～41%之间)。结论根据药敏试验结果选择用药是提高临床抗感染治疗成功率及延缓细菌耐药的基本原则之一。碳青霉烯类目前仍然是治疗ESBL-EC及ESBL-KP的首选药物,含酶抑制剂及四代头孢类药头孢吡肟加阿米卡星依然是较优的选择。

Objective To investigate the drug resistance ofextended-spectrum β-lactamase-producing E. co- li （ESBL-EC） and ESBL-producing pneumoniae （ESBL-KP） in hospital. Methods The data of the resistance of ESBL-EC and ESBL-KP to commonly used antibiotics from clinical microbiology laboratory in the hospital from 2010 to 2011were analyzed. Results ESBL-EC and ESBL-KP were all totally sensitive to imipenem and cilastatin sodium, and highly sensitive to cefoxitin and amikacin （〉80%）. ESBL-EC and ESBL-KP showed descending drug re- sistance to ceftazidime and cefepime, but they were totally resistant to most β-lactam antibiotics （ampicillin, piperacil- lin, ticarcillin, cefazolin, ceftriaxone, cefotaxime, cefoperazone）. ESBL-EC were highly sensitive to β-1actamase inhib- itors （〉92%）, but ESBL-KP were less sensitive to β-lactamase inhibitors （50%~89% to cefoperazone/sulbactam and 67%-92% to piperacillin/tazobactam）. The drug resistance rates of ESBL-EC to levofloxacin were 57%-81% and that of ESBL-KP to levofloxacin were 16%--41%. Conclusion Choosing antibiotics according to the susceptibility test is one of the principles to increase the success rate of anti-infection treatment and reduce drug resistance. Carbapenems are the premium choice for ESBLoEC and ESBL-KP. β-lactamase inhibitors, cefoxitin and arnikacin are also good choices.