产超广谱β-内酰胺酶大肠埃希菌与肺炎克雷伯菌2013-2015年耐药谱动态分析

Dynamic analysis of drug resistance spectrums of extended-spectrum β-lactamses-producing Escherichia coli,Klebsiella pneumoniae in 2013-2015

目的分析2013-2015年医院产ESBLs大肠埃希菌和肺炎克雷伯菌耐药性变迁情况,旨在合理制定医院感染抗菌治疗方案。方法选取医院2013年1月-2015年12月诊治的感染性疾病患者标本,分析各类标本中产ESBLs大肠埃希菌和肺炎克雷伯菌检出情况,分析病原菌耐药性,同时对所得数据行统计比较。结果 2013年-2015年产ESBLs大肠埃希菌株检出率依次是7.92%、9.30%、8.77%,肺炎克雷伯菌检出率依次是21.31%、20.57%、20.17%,各年份产ESBLs大肠埃希菌株和肺炎克雷伯菌检出率,无显著性差异;产ESBLs大肠埃希菌对头孢菌素、青霉素类耐药性最高,2014年头孢吡肟耐药率为100.00%,对替加环素、美罗培南、亚胺培南耐药性较低,其中替加环素为0%,且2015年产ESBLs大肠埃希菌对米诺环素、头孢噻肟耐药率显著高于2014年水平(P<0.05);2013年-2015年肺炎克雷伯菌对氨苄西林耐药率最高,对哌拉西林、环丙沙星、头孢类药物耐药率不断升高,肺炎克雷伯菌对亚胺培南、美罗培南耐药率低。结论产ESBLs大肠埃希菌及肺炎克雷伯菌均为感染性疾病的主要致病菌,二者对常见抗菌药物均有较高耐药性,且随着年代更替,其耐药谱有一定变迁。

OBJECTIVE To investigate the change of drug resistance of extended-spectrum β-lactamses （ESBLs）-producing Escherichia coli,Klebsiella pneumoniae in 2013-2015 so as to formulate reasonable antibacterial treatment programs.METHODS The specimens were collected from the patients with infectious diseases who were treated in the hospital from Jan 2013 to Dec 2015,the isolation rates of the ESBLs-producing E.coli and K.pneumoniae in the specimens were analyzed,the drug resistance of the pathogens was observed,and the obtained data were statistically analyzed and compared.RESULTS The isolation rate of ESBLs producing E.coli was 7.92 % in 2013,9.30% in 2014,8.77% in 2015;the isolation rate of K.pneumoniae was 21.31% in 2013,20.57% in 2014,20.17% in 2015;there was no significant difference in the isolation rate of ESBLs producing E.coli or K.pneumoniae among 2013,2014,and 2015.The drug resistance rate of the ESBLs-producing E.coli to cephalosporins and penicillin was the highest,the drug resistance rate to cefepime was 100.00% in 2014,the drug resistance rate to dgecycline,rneropenem,and imipenem was relatively low,the drug resistance rate to tigecycline was 0%,and the drug resistance rates of the ESBLs-producing E.coli to minocycline and cefotaxime was significently higher in 2015 than in 2014 （P〈0.01）.The drug resistance rate of the ESBLs-producing K.pneumoniae to ampicillin was the highest in 2013-2015,the drug resistance rate to piperacillin,ciprofloxacin,and cephalosporins was increased,and the drug resistance rate of the K.pneumoniae to imipenem and meropenem was low.CONCLUSION The ESBLs-producing E.coli and K.pneumoniae are the predominant species of pathogens causing the infectious diseases and are highly resistant to the commonly used antibiotics.The drug resistance spectrum vary with the time.