上呼吸道反复感染患儿产ESBLs大肠埃希菌及肺炎克雷伯菌的耐药性分析

Detection of ESBLs-producing Escherichia coli and Klebsiella pneumoniae in children with recurrent upper respiratory tract infections

目的检测上呼吸道反复感染患儿产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌的耐药情况。方法用美国MICROSCAN细菌分析软件对反复上呼吸道感染患儿进行咽拭子培养、菌株鉴定及药敏试验,结果按美国临床实验室标准化协会(CLSI)标准判读,并进行回顾性分析。结果在分离出的260株革兰阴性菌中,大肠埃希菌186例,肺炎克雷伯菌74例,其中产ESBLs菌株分别为78例和42例,大肠埃希菌产ESBLs病原菌检出率为43.01%(80/186);肺炎克雷伯菌产ESBLs病原菌检出率为48.65%(36/74)。产超ESBLs菌株对常用抗菌药物耐药率明显高于未产ESBLs菌株,二者对亚胺培南、哌拉西林/他唑巴坦及阿米卡星高度敏感,但对部分头孢类抗菌药物呈多重耐药性。结论反复上呼吸道感染患儿产ESBLs病原菌检出率较高;该类细菌对常规抗菌药物呈较高耐药性,参照有效的病原菌培养及药物敏感试验,是保证临床抗菌治疗效果的关键。

Objective To detect the extended-spectrumβ-lactamases（ESBLs）producing pathogens by the throat swab culture in children with recurrent upper respiratory tract infections,and to analyze the drug resistance.Methods The throat swab culture, bacterial strain identification and drug sensitivity test were performed in the children with recurrent upper respiratory tract infec-tions by using the American MICROSCAN bacterial analysis software.The results were interpreted according to the standards of American Clinical and Laboratory Standards Institute（CLSI）.The retrospective analysis was performed.Results In 260 strains of isolated Gram-negative bacteria,186 cases were Escherichia coli and 74 cases were Klebsiella pneumoniae,in which ESBLs-produ-cing strains were 78 cases and 42 cases respectively.The detection rate of the ESBLs-producing strains in Escherichia coli was 43.01%（80/186）,and which in Klebsiella pneumoniae was 48.65%（36/74）.The resistance rates of ESBLs-producing strains to commonly used antibiotics were significantly higher than those of non-ESBLs-producing strains,both strains were highly sensitive to imipenem,piperacillin sulbactam and amikacin,but showed the multiple drug resistance to some cephalosporin antibiotics.Conclu-sion The detection rate of ESBLs-producing pathogens in the children with recurrent upper respiratory tract infection is higher. These bacteria show the higher resistance to conventional antibiotics,and it is the key to ensure clinical antimicrobial therapeutic ef-ficacy according to the effective pathogen culture and the drug susceptibility testing.