产超广谱β-内酰胺酶菌株老年人医院内下呼吸道感染及药敏分析

Infection and drug sensitivity analysis of bacterial strains producing extended-spectrum β-lactamases of hospital-acquired lower respiratory tract in the elderly

目的 分析产超广谱 β 内酰胺酶 (ESBLs)菌株老年人医院内下呼吸道感染的危险因素及药敏试验情况。方法 对 6 2例产ESBLs肺炎克雷伯杆菌 ,大肠埃希菌老年人医院内下呼吸道感染的基础疾病 ,医源性因素进行统计分析 ,对判断为ESBLs的菌株采用Kirby Bauer(KB)法测定对常用抗生素的药物敏感性。 结果 所有患者都有严重的慢性基础疾病 ,其中慢性肺科疾病占 2 5 .8% (16 / 6 2 ) ,恶性肿瘤和脑系科疾病均各占 2 1.0 %(13/ 6 2 ) ,入住ICU或CCU占 35 .5 % (2 2 / 6 2 ) ,使用广谱抗生素达 90 .3 % (5 6 / 6 2 ) ,使用鼻饲管和雾化器占38.7% (2 4/ 6 2 )和 35 .5 % (2 2 / 6 2 ) ,人工气道机械通气者占 2 4.2 % (15 / 6 2 ) ,应用制酸剂占 30 .7% (19/ 6 2 )。药敏监测表明产ESBLs菌株对亚胺培南敏感性达 10 0 % ,哌拉西林 /他唑巴坦敏感性为 78.6 %～ 79.4%。头孢西丁敏感性为 70 .6 %～ 71.5 %。阿米卡星 ,替卡西林 /棒酸敏感性一般。结论 临床上可以选用亚胺培南、哌拉西林/他唑巴坦、头孢霉素类头孢西丁等作为ESBLs感染菌株的治疗。应避免头孢三代 ,单环 β 内酰胺类抗生素的应用。细菌室应密切配合临床工作。合理应用抗生素 ,遏制ESBLs菌株的流行 。

Objective Analyzing the risk factor of hospital acquired lower respiratory tract infection of strains producing extended spectrum beta lactamases in the elderly (ESBLs) and the statistic analysis of drug sensitivity test. Methods Statistical analysis of the underlying diseases and the Iatrogenic factor in 62 cases of hospital acquired lower respiratory tract infection of Klebsiella pueumoniae or Escherichia coli that produced ESBLs. The determination of the drug sensitivity to commonly used antibiotics for the strains producing ESBLs was cloned by Kirby Bauer (KB)method.Results All patients have severe chronic underlying diseases. There were 25.8%(22/62) chronic lung disease and 21.0%(13/62)malignant tumor and neurologic diseases. 35.5%(22/62) of them were admitted to ICU or CCU of whom 90.3% (56/62) used broad spectrum antibiotic, 38.7%(24/62) used nasal feeding tube, 35.5%(22/62) with nebulizer, 24.2%(15/62) were with mechanical ventilation, and 30.7%(19/62) were given antacid thrapy. The monitoring results of drug sensitivity indicated the strains producing ESBLs showed 100% sensitivity to Imipenem, 78.6～79.4% to piperacillin/Tazobactam, 70.6～71.5% to cefoxitine, but fair to Amikacin and Ticarcillin/Potassium clavulanate. Conclusion Imipenem, piperacillin/Tazobactam, Cefoxitine etc. can be used to treat the patients infected with strains producing ESBLs'. And the third generation cephalosprins and monobactams should be avoided. Rational use of antibiotics is of primary importance.