医院感染大肠埃希菌及肺炎克雷伯菌的产酶率与耐药性分析

Analysis of drug resistance and enzyme production rate of Escherichia coli and Klebsiella pneumoniain hospital infections

目的了解2006年1月-2011年12月大肠埃希菌和肺炎克雷伯菌的分布及耐药性,为医院感染的临床诊治提供依据。方法收集2006年1月-2011年12月住院患者的各种感染标本,常规方法培养分离细菌,用VITEK-2全自动细菌分析仪鉴定到种,超广谱β-内酰胺酶(ESBLs)检测应用双纸片确认法,药敏试验采用K-B纸片扩散法,按CLSI规定的标准操作及判断结果进行。结果医院感染标本中共分离出大肠埃希菌3 191株、肺炎克雷伯菌2 305株,标本来源分布大肠埃希菌主要来自尿液和痰液,分别占38.1%和25.9%,肺炎克雷伯菌主要来自痰液,占70.6%;科室分布大肠埃希菌主要来自消化内科和肾脏内科,分别占14.2%和8.4%,肺炎克雷伯菌主要分离自神经外科和神经内科,分别占21.2%、13.8%;大肠埃希菌产ESBLs菌检出率为60.7%,肺炎克雷伯菌产ESBLs菌检出率为52.1%;未发现耐亚胺培南和美罗培南大肠埃希菌,肺炎克雷伯菌对亚胺培南和美罗培南耐药率分别为0.1%和0.2%。结论大肠埃希菌和肺炎克雷伯菌为临床医院感染的重要病原菌,产ESBLs菌株检出率均较高,在临床的感染诊治中应高度重视,加强监测,临床应根据耐药表型检测结果合理选用抗菌药物。

OBJECTIVE To understand the distribution and drug resistance of Escherichia coli （ECO） and Klebsiel- la pneumoniae（KPN） from Jan. 2006 to Dec. 2011 in Xijing Hospital so as to provide the basis for diagnosis and treatment of nosocomial infections. METHODS The specimens of patients with variety of infections from Jan. 2006 to Dec. 2011 were gathered, and isolated by normal methods and identified by using VITEK-11 analyzer. ESBLs were examined by double disk method and drug susceptibility test adopted K-B disk diffusion methods. The results were judged by CLSI rules. RESULTS A total of 3191 strains of E. coli and 2305 strains of K. pneumoniae were isolated. E. coli was mainly isolated from urine and sputamentum, accounting for 38. 1% and 25. 9% respectively. K. pneumoniae was mainly from urine which took up 70. 6 % % E. coli mainly from the department of digestion and nephrology, accounting for 14.2% and 8.4%, and K. pneumoniae was mainly from department of neurosurgery and neurology, accounting for 21. 2% and 13.8%. The detectable rates of E. coli ESBLs and K. pneumoniae ESBLs were 60.7% and 52.10% separately. Imipenem-resistant and meropenem-resistant E. coli were not found, and the drug-resistance rates of K. pneumoniae to imipenem and meropenem were 0. 1 % and 0.2 respectively. CONCLUSION E. coli and K. pneumoniae are the main pathogens in clinical nosocomial infections which obtain a high level of ESBLs producing rate. Therefore more attention and stronger detection should be put on them and it should make a better decision of using antibiotics relying on drug sensitivity tests.