产ESBLs大肠埃希菌和肺炎克雷伯菌的检测结果分析

Analysis of detection results of extended spectum β-Lactamases producing Escherichia coli and Klebsiella pneumoniae

目的了解产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(ECO)和肺炎克雷伯菌(KPN)的临床分布及耐药性,为临床合理用药提供依据。方法采用VITEK-2全自动微生物鉴定/药敏分析系统对细菌进行菌株鉴定及药敏分析,对产ESBLs的ECO和KPN的临床分布与耐药结果用WHONET 5.4软件进行统计分析,应用SPSS 11.5软件进行卡方检验。结果 1 955株菌中共检出产ESBLs菌916株,检出率为46.9%,其中ECO 570株,检出率为58.9%,KPN 346株,检出率为35.0%,产ESBLs菌主要从痰液和尿液中检出,主要来自ICU、普外科和神经外科;产ESBLs菌对多种抗生素的耐药率明显高于非产ESBLs菌,差异有统计学意义(P<0.05),对哌拉西林/他唑巴坦、头孢替坦和亚胺培南较敏感。结论产ESBLs菌株所致的感染以泌尿道感染和呼吸道感染为主,且呈多重耐药性,临床上要重视对产ESBLs菌株的检测和细菌耐药监测,有效控制产ESBLs菌株的产生和流行。

Objective To study the clinical distribution and drug resistance of extended-spectrum β-lactamases（ESBLs） producing Escherichia coli and Klebsiella pneumoniae for guiding the clinical drug use.Methods Bacterial straina and their drug sensitivity were identified by using VITEK-2 automatic microorganism identification/drug sensitivity analysis system.Statistical analysis of the clinical distribution and drug resistance results of ESBLs-producing E.coli and K.pneumonia were performed by WHONET 5.4 software based on chi-square test using SPSS 11.5 software.Results Among 1 955 isolates,916 strains（46.9%） were detected as producing ESBLs,including 58.9%（570/967） of E.coli and 35.0%（346/988） of K.pneumoniae.The main source of these ESBLs-producing strains were urine and sputum specimens from ICUs,general surgery departments and neurosurgery departments.The drug resistance rates of ESBLs-producing strains to multiple antibiotics were higher than those of non ESBLs-producing strains（P0.005）.Most isolated strains were sensitive to piperacillin/tazobactam,cefotetan,and imipenem.Conclusion The ESBLs-producing mainly cause infections of urinary tract and respiratory tract,and have resistance to many antibiotics.It is important to monitor ESBLs-producing strains and their drug resistance,and effectively control the emergence and spread of ESBLs-producing strains