大肠埃希菌和克雷伯杆菌产超广谱β-内酰胺酶的检出及其耐药性

Detection and Comparative Study of Antibiotic Resistance in Clinical Isolates of Klebsiella and Escherichia Coli Producing Extended-spectrum Beta-lactamases

目的 :通过对大肠埃希菌和克雷伯杆菌产超广谱 β 内酰胺酶 (ESBLs)的检出及耐药性分析 ,了解产ESBLs大肠埃希菌和克雷伯杆菌的耐药特性 ,以及指导临床用药。方法 :NCCLS推荐纸片的确认试验检出ESBLs阳性的大肠埃希菌和克雷伯杆菌 ,用最低抑菌浓度(MIC)法和K B法对大肠埃希菌和克雷伯杆菌进行药物敏感性试验并用统计学方法进行耐药分析。结果 :大肠埃希菌和克雷伯杆菌是我院临床分离的两种主要革兰氏阴性杆菌 ,其ESBLs的检出率分别为 9.7%和 11.1% ,单用头孢他啶 头孢他啶 /克拉维酸作底物会造成 6 0 .7%的漏检 ,ESBLs阳性菌的耐药率比ESBLs阴性菌显著升高。结论 :ESBLs是大肠埃希菌和克雷伯杆菌对头孢菌素产生耐药的主要原因 ,ESBL阳性菌的耐药性强且多重耐药ESBL阳性菌与ESBL阴性菌的耐药率有显著差异 ,ESBLs表型检测应同时选择两种以上底物 ,IMP为治疗ESBLs的首选药物。

Objective:By detection and comparative study of antibiotic resistance in clinical isolates of Klebsiella and Escherichia coli producing extended-spectrum beta-lactamases study the methods of raising the detection rate of ESBLs-producing isolates and the antibiotic resistance of these strains.Methods:The ESBLs-producing isolates were detected by Kl,and Coli and drug susceptible tests were made. Results:There was no significant difference between the way of double-disc synergy test and NCCLS single-disc diffusion confirmatory test ( P >0.01). ESBLs-producing isolates had higher resistance rate to many kinds of antibiotics. However all tested strains were susceptive to imipenem. Conclusions:A double-disc synergy test has exceptionally high veracity,but must be used with more than two basic substances. IMP is the first choice to deal with ESBLs strains.