肠杆菌科产ESBLs细菌的临床耐药研究

Clinical drug resistance of Enterobacteriaceae producing ESBLs bacteria

目的研究肠杆菌科产ESBLs细菌的临床耐药情况。方法选取我院2014年7月~2016年9月的4265株肠杆菌科病原菌,将其采用生物梅里埃分析仪进行鉴定,确认其为产ESBLs菌株后,对其进行药敏检测,分析产ESBLs细菌在临床各种抗生素中的耐药情况。结果产ESBLs细菌主要在奇异变形杆菌、产酸克雷伯菌、肺炎克雷伯菌、大肠埃希菌中分布,在4265株肠杆菌病原菌中,产ESBLs细菌有2415株,检出率为56.62%,人体脓液、分泌物、尿液、胆汁的检出率较高,产ESBLs细菌在不同标本中的检出率比较,差异有统计学意义(P<0.05)。产ESBLs细菌在部分抗生素具有耐药性,大部分抗生素对产ESBLs细菌完全无效,而亚胺培南对产ESBLs菌株敏感。结论在肠杆菌病原菌中产ESBLs细菌占主要菌种,且大多数抗菌药物治疗无效,目前亚胺培南为临床治疗产ESBLs细菌的最后防线,建议临床在给予患者使用抗菌药物之前,应监测耐药菌,遵医嘱进行合理用药,这是控制和减少产ESBLs细菌的主要手段。

Objective To study the clinical drug resistance of Enterobacteriaceae producing ESBLs bacteria.Methods 4265 strains of Enterobacteriaceae pathogenic bacteria in our hospital from July 2014 to September 2016 were selected, biological Meiliai analyzer was used for identification,after identification of ESBLs producing strain,drug sensitivity test was carried out to analyze the drug resistance of ESBLs producing bacteria in clinical antibiotics.Results Among 4265 strains of Enterobacteriaceae,the ESBLs producing bacteria were mainly distributed in Proteus mirabilis,Klebsiella, Klebsiella pneumoniae and Escherichia coli.There were 2415 strains of ESBLs bacteria,the detection rate was 56.62%. The detection rate of ESBLs bacteria in pus,secretion,urine and bile in human body were higher.There was significant difference in the detection rate of ESBLs bacteria in different samples （P〈0.05）.ESBLs producing bacteria were resistant to some antibiotics,most antibiotics were ineffective in producing ESBLs bacteria,while Imipenem was sensitive to ESBLs producing strains.Conclusion Among the pathogenic bacteria of Enterobacteriaceae,ESBLs bacteria are the main bacteria, and most of antibiotics are ineffective,Imipenem is the last line of defense against ESBLs bacteria.It is suggested that antibiotics should be monitored before the clinical use of antimicrobial agents, and rational use of drugs according to the doctor＇s advice is the main means to control and reduce the production of ESBLs bacteria.