我院儿科产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的临床分布与耐药性分析

Clinical Distribution and Drug Resistance of ESBLs-Producing Escherichia Coli and Klebsiella Pneumoniae in Our Hospital

目的：分析我院儿科产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和产ESBLs肺炎克雷伯菌的临床分布特征及耐药性,为临床合理用药提供参考。方法：对2012年12月至2015年12月在我院儿科住院的感染性疾病患儿送检的标本进行培养,采用VITEK细菌鉴定与药敏分析系统对菌落进行菌种鉴定及药敏分析。结果：临床共分离大肠埃希菌86株,其中产ESBLs菌60株（69.77%）,83.33%（50/60）来源于痰液标本;肺炎克雷伯菌62株,其中产ESBLs菌57株（91.94%）,92.98%（53/57）来源于痰液标本。产ESBLs大肠埃希菌对美罗培南、环丙沙星、阿米卡星、左氧氟沙星的耐药率分别为0%、1.67%、3.33%、3.33%,对其他抗菌药物的耐药率为5.00%-96.66%;产ESBLs肺炎克雷伯菌对美罗培南、环丙沙星、左氧氟沙星的耐药率均为0%,对其他抗菌药物的耐药率为3.51%-92.98%。结论：产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌主要来源于痰液标本,对常用抗菌药物的耐药情况基本一致（β-内酰胺酶抑制剂复方制剂除外）。两者对大部分头孢菌素耐药率较高（头孢替坦除外）,对碳青霉烯类（美罗培南、亚胺培南）、氨基糖苷类（阿米卡星、庆大霉素、妥布霉素）、喹诺酮类（左氧氟沙星、环丙沙星）的耐药率较低。临床医师应结合药敏试验结果,合理选用抗菌药物,以减少细菌耐药性的产生。

Objective： To analyze clinical distribution and drug resistance of extended-spectrum β-lactamase（ESBLs） Escherichia coli（E.coli） and ESBLs-producing Klebsiella pneumonia,to provide reference for clinical rational drug use.Methods： Specimens of pediatric patients from December 2012 to December 2015 in our hospital were cultivated,VITEK bacterial identification and drug susceptibility analysis system were used to do bacteria identification and drug susceptibility analysis of colony.Results： ESBLs-producing E.coli detection rate was 69.77% in the clinical distribution of 86 strains of E.coli,the sputum specimens were 83.33%.ESBLsproducing Klebsiella pneumonia bacteria detection rate was 91.94% in 62 strains of Klebsiella pneumonia,including sputum specimens were 92.98%.The resistance rates of ESBLs-producing E.coli to meropenem,ciprofloxacin,amikacin and ofloxacin were 0%,1.67%,3.33%,3.33% respectively,for other antimicrobial resistant rates were 5.00%- 96.66%.The resistance rates of ESBLs-producing Klebsiella pneumonia to meropenem,ciprofloxacin and ofloxacin were 0% respectively,for other antimicrobial resistant rates were 3.51%- 92.98%.Conclusion： ESBLs-producing E.coli and Klebsiella pneumonia mainly come from sputum samples.Besides beta lactamase,they have the consistent sensitivity to the antibacterial drugs.Besides cefotetan,they have low consistent sensitivity to most of the cephalosporin antibiotics,and have a high resistance on carbapenems antibiotics（imipenem and meropenem）, aminoglycosides antibiotics（amikacin,gentamycin,tobramycin）,fluoroquinolone antibiotics（levofloxacin and ciprofloxacin）.Clinical drug treatment should be combination of medicine sensitive experiment,choose reasonable and effective antimicrobials,reduce the abuse of antibacterial agents and bacteria resistant,.