大肠埃希菌和肺炎克雷伯菌对三种氨基糖苷类抗生素的耐药性分析

Drug resistance of Escherichia coli and Klebsiella pneumoniae to three kinds of aminoglycosides

目的评价庆大霉素、妥布霉素及阿米卡星三种氨基糖苷类抗生素(AGs)对大肠埃希菌和肺炎克雷伯菌的体外抗菌活性。方法对902株大肠埃希菌和404株肺炎克雷伯菌,采用VITEK-2全自动微生物分析仪配套的AST-GN13药敏卡进行庆大霉素、妥布霉素及阿米卡星的体外药敏试验。结果大肠埃希菌和肺炎克雷伯菌的产超广谱β-内酰胺酶(ESBLs)菌株检出率分别为40.8%和36.6%;产ESBLs的大肠埃希菌对庆大霉素、妥布霉素及阿米卡星的敏感率分别为42.4%、39.1%和96.5%,与非产ESBLs菌株比较,敏感率差异均有统计学意义(P<0.01);产ESBLs的肺炎克雷伯菌对庆大霉素、妥布霉素及阿米卡星的敏感率分别为64.2%、62.8%和91.9%,与非产ESBLs菌株比较,敏感率差异均有统计学意义(P<0.01);阿米卡星对产与非产ESBLs的大肠埃希菌和肺炎克雷伯菌均高度敏感,敏感率均在91%以上。结论本地区大肠埃希菌和肺炎克雷伯菌产ESBLs菌株流行严重,ESBLs的产生可使大肠埃希菌和肺炎克雷伯菌对AGs的耐药情况加重,提示ESBLs和AGs引起的耐药可能存在一定的相关性。

Objective To evaluate the in vitro antibacterial activity of gentamicin, tobramycin and amikacin against Escherichia coli and Klebsiella pneumoniae. Methods In vitro drug susceptibility testing of 902 strains of Escherichia coli and 404 strains of Klebsiella pneumoniae to gentamicin, tobramycin and amikacin were performed by using VITEK-2 compact automated microorganism analyzer sup- porting drug sensitivity test card. Results The detection rates of extended-spectrum β-lactamases （ESBLs） producing strains of Esche- richia coli and Klebsiella pneumoniae were 40.8% and 36.6% respectively; the sensitivity rates of ESBLs-producing Escherichia coli to gentamicin, tobramycin and amikacin were 42.4%, 39.1% and 96.5% respectively; compared with non-ESBLs-producing strains, the differences were statistically significant （P 〈0. 01 ）. The sensitivity rates of ESBLs-producing Klebsiella pneumoniae to gentamicin, tobra- myein and amikacin were 64.2% , 62.8% and 91.9% respectively; compared with non-ESBLs-producing strains, the differences were statistically significant （ P 〈 0.01 ）. Both ESBLs-producing and non-ESBLs-producing Escherichia coli and Klebsiella pneumoniae were highly sensitive to amikacin, with the sensitivity rates above 91%. Conclusion ESBLs-producing strains of Escherichia coli and Klebsiel- la pneumoniae are predominant in this region. The resistance of Escherichia coli and KlebsieUa pneumoniae to aminoglycosides （AGs） tends to be more serious because of ESBLs production, suggesting some relationship between ESBLs and AGs resistance of Escherichia coli and Klebsiella pneumoniae.