泌尿系统感染大肠埃希菌与肺炎克雷伯菌产酶及耐药趋势研究

Enzyme-producing Escherichia coli and Klebsiella pneumoniae causing urinary tract infections and trend of drug resistance

目的分析泌尿系感染大肠埃希菌与肺炎克雷伯菌的产酶状况以及耐药性的变化,以指导临床医师合理使用抗菌药物。方法收集2010年1月1日-2012年12月31日医院1 974例住院及门诊患者送检的中段尿标本中培养分离出的菌株,采用法国生物梅里埃公司ATB型细菌分析系统对菌株进行鉴定和药敏分析;应用WHONET5.6软件进行结果统计分析。结果 3年从泌尿系统感染标本中分离出大肠埃希菌242株,其中产ESBLs菌158株,占65.3%;分离出肺炎克雷伯菌224株,其中产ESBLs菌88株,占39.3%;大肠埃希菌对环丙沙星及二、三代头孢菌素耐药率均>53.6%,肺炎克雷伯菌对环丙沙星及二、三代头孢菌素耐药率均>35.7%;两种菌均未发现耐碳青霉烯类药物的菌株。结论泌尿系感染的大肠埃希菌、肺炎克雷伯菌具有多药耐药性,临床医师应重视细菌学培养,用药敏试验结果指导临床合理地应用抗菌药物,以减少产ESBLs菌的产生。

OBJECTIVE To analyze production of enzyme in the Escherichia coli and Klebsiella pneumoniae causing urinary tract infections and observe the change of drug resistance so as to provide guidance for reasonablg clinical use of antibiotics. METHODS From Jan 1, 2010 to Dec 31, 2012, the strains were collected from the midstream urine specimens obtained from 1974 hospitalized patients and outpatient departments, then the identification of the strains was conducted with ATB bacteria analyzer of Biolvlerieux , the drug susceptibility testing was performed, and the statistical analysis was performed by WHONET5. 6 software. RESULTS A total of 242 strains of Escherichia coli have been isolated from the specimens obtained from the patients with urinary tract infections during the three years, among which there were 158 （65.3%） strains with ESBLs-producing; totally 224 strains of K. pneumoniae have been isolated, among which there were 88 （39. 3 %） strains with ESBLs-producing. The drug resistance rates of the E. coli to ciprofloxacin and second and third generation cephalosporins were more than 53. 6 %; the drug resistance rates of the K. pneumoniae to ciprofloxacin and second and third generation cephalosporins were more than 35. 7 %; the carbapenems-resistant strains were not been detected. CONCLUSION The E. coli and K. pneumoniae strains causing urinary tract infections are multidrug-resistant; the clinicians should focus on the bacteriological culture and reasonably use antibiotics according to the result of drug susceptibility testing so as to reduce the ESBLs-producing strains.