老年与中青年病人产ESBLs大肠埃希菌的分布及耐药性对比分析

Analysis of distribution and drug resistance of ESBLs-producing Escherichia coli in elderly or adult patients

目的探讨老年与中青年病人产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的分布及耐药性,为临床医师抗感染治疗提供实验室依据。方法分别选取2015年1~12月住院的老年与中青年病人为研究对象,按照美国临床与实验室标准协会(CLSI)推荐的方法进行ESBLs初步筛选和表型确证试验,对产ESBLs的菌株进行耐药性分析,并对2个人群结果进行比较。结果老年病人中产ESBLs大肠埃希菌主要分布在泌尿外科和普通外科,分别占14.42%和13.46%;中青年组病人中产ESBLs大肠埃希菌主要分布在妇产科和普通外科,分别占21.00%和13.00%。老年与中青年病人产ESBLs大肠埃希菌对大多数β-内酰胺类抗菌药物的耐药率均>90%,对碳青霉烯类抗菌药物均敏感,耐药率为0。除氨曲南和头孢吡肟外,老年病人与中青年病人产ESBLs大肠埃希菌的耐药率差异无统计学意义(P>0.05)。结论碳青霉烯类是目前治疗产ESBLs大肠埃希菌最有效的一类抗菌药物,医师应根据药敏试验结果合理应用抗生素。

Objective To explore the drug resistance status of Escherichia coli（E.coli）producing extended-spectrum beta-lactamase（ESBLs） in hospitalized elderly and adult patients,so as to provide references for rational use of antibiotics.Methods ESBLs-producing E.coli isolated from elderly and adult patients in our hospital from January 2015 to December 2015 were collected and the drug sensitivity test was performed.The ESBLs preliminary screening and the phenotypic confirmatory test were conducted according to the guideline of CLSI,and the result of the two populations were compared.Results E.coli strains producing-ESBLs of hospitalized elderly patients were mainly isolated from department of urinary surgery（14.42%） and department of general surgery（13.46%）;E.coli strains producing ESBLs of hospitalized adult patients were mainly isolated from department of gynaecology and obstetrics（21.00%） and department of general surgery（13.00%）.The drug resistance rates to betalactam antibiotic of E.coli producing ESBLs in elderly and adult patients were more than 90%,while the drug resistance rate to carbapenem was 0.Except aztreonam and cefepime,the difference in the resistance rates of E.coli producing ESBLs between elderly and adult patients were not statisticly significant（P〈0.05）.Conclusions The most effective antimicrobial drugs at present for the treatment of E.coli producing ESBLs are carbopenems.Bacteria culture and drug resistance detection need to be strengthened to help clinical rational use of antibiotics for patients.