ESBLs在大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌中的检出率及耐药情况比较

Comparsion of detection rate and drug resistance of ESBLs in escherichia coli, klebsiella pneumonia and enterobacter cloacae

目的分析并对比ESBLs（超广谱内酰胺酶）在大肠埃希菌、阴沟肠杆菌以及肺炎克雷伯菌中的检出率、耐药情况。方法以我院2011年6月~2015年9月间内科收治的106例化脓性胆管炎患者为临床研究对象,分别记录其胆汁大肠埃希菌、阴沟肠杆菌以及肺炎克雷伯菌的培养结果,并通过药敏测定和试验检查ESBLs在各类菌种中的耐药情况。结果在154株实验培养菌中,共有62株产ESBLs株,其总检出率为40.3%。而在62株产ESBLs株中,大肠埃希菌检出33株（53.2%）,阴沟肠杆菌检出8株（22.2%）,肺炎克雷伯菌检出21株（37.5%）。大肠埃希菌、肺炎克雷伯菌的检出率要明显高于阴沟肠杆菌,x12=22.77,其对比均具有统计学意义（P〈0.05）;肺炎克雷伯菌的检出率要明显高于阴沟肠杆菌,x22=7.61,其对比有统计学学意义（P〈0.05）。在各类标本中,在胆管结石病例胆汁培养结果中,产ESBLs肺炎克雷伯菌（85.7%）的检出数量最高;在胆管恶性梗阻病例中,产ESBLs阴沟肠杆菌、大肠埃希菌所占比例较高。产ESBLs阴沟肠杆菌、大肠埃希菌和肺炎克雷伯菌均对阿莫西林耐药,且耐药率为100%;3种菌株对头孢类抗菌药耐药率较高,3种菌株对碳青霉烯类耐药率比较低。产ESBLs阴沟肠杆菌的耐药率要低于产ESBLs大肠埃希菌和肺炎克雷伯菌,特别是在庆大霉素、环丙沙星以及头孢类药物上差距最为明显。结论对于产ESBLs（超广谱内酰胺酶）菌株导致的感染疾病,结合药敏试验的结果来合理选择抗生素用药,是延滞细菌耐药性出现的关键,也是临床合理用药的重要保证。

Objective To analyze and compare detection rate and drug resistance of ESBLs（extended spectrum beta lactamase） in escherichia coli, klebsiella pneumonia and enterobacter cloacae. Methods 116 patients with suppurative cholangitis who were admitted to department of internal medicine of our hospital from June 2011 to September 2011 were selected as clinical research objects. The culture results of escherichia coli, klebsiella pneumonia and enterobacter cloacae of their bile were respectively detected. Drug resistances of ESBLs in every strain were detected by drug sensitive tests. Results Among 154 experimental culture strains, a total of 62 strains produced ESBLs strains and the total detection rate was 40.3%. In 62 strains producing ESBLs strains, escherichia coli was detected in 33 strains（53.2%）, enterobacter cloacae was detected in 8 strains（22.2%） and klebsiella pneumonia was detected in 21 strains（37.5%）. Detection rate of escherichia coli and klebsiella pneumonia was significantly higher than that of the enterobacter cloacae, x12=22.77. The comparison had statistical significance（P 〈0.05）. Detection rate of klebsiella pneumonia was significantly higher than that of the enterobacter cloacae, x22=7.61. The comparison had statistical significance（P〈 0.05）. In all kinds of specimens, detection rate of klebsiella pneumonia producing ESBLs was the highest（85.7%） in bile culture results of bile duct calculi cases. In malignant biliary obstruction cases, detection rates of escherichia coli, and enterobacter cloacae producing ESBLs were higher. Enterobacter cloacae, escherichia coli and klebsiella pneumonia producing ESBLs were all resistant to amoxicillin. And the rate of drug resistance was 100%. 3 strains were of high resistance to cephalosporin antibiotics and 3 strains were of low resistance to carbopenems. Rate of drug resistance of enterobacter cloacae producing ESBLs were lower than that of escherichia coli and klebsiella pneumonia. The difference was most significant especially in gentamicin, ciprofloxacin and cephalosporin medicine. Conclusion For infectious disease caused by strains producing ESBLs, properly choosing antibiotics in combination with drug sensitive test is the key to delay the occurrence of bacteria resistance and an important guarantee of clinically rational medication.