患儿呼吸道感染产超广谱β-内酰胺酶病原菌的耐药性分析

Drug resistance of extended-spectrumβ-lactamases-producing pathogens causing respiratory tract infections in children

目的分析呼吸道感染患儿产超广谱β-内酰胺酶(ESBLs)病原菌的耐药情况及基因表型,以便提高治疗效率。方法收集2016年6月-12月104例呼吸道感染患儿痰液标本分离的ESBLS病原菌,检测ESBLS病原菌对常用抗菌药物的耐药情况,并采用PCR技术分析ESBLS病原菌的耐药基因。结果 104份痰液标本共分离出产ESBLs病原菌32株,其中肺炎克雷伯菌14株,大肠埃希菌14株,其他4株;32株产ESBLs细菌对头孢类抗菌药物高度耐药,对头孢唑林、头孢呋辛、头孢曲松的耐药率达100.00%,对β-内酰胺类抗菌药物/酶抑制剂复合物耐药率为21.88%~34.38%,而对碳青霉烯类抗菌药物的耐药率为0;CTX-M-9型菌株检出率最高,检出率为31.25%,其次为TEM型菌株,检出率为25.00%,未检出OXA-10型、CTX-M-2型与CTX-M-8型菌株。结论呼吸道感染患儿产ESBLs细菌具有多药耐药的表型特征,对头孢类抗菌药物高度耐药,对酶抑制剂复合物部分耐药,而对碳青霉烯类抗菌药物高度敏感,临床应根据药敏结果合理用药。

OBJECTIVE To investigate the drug resistance and genetic phenotypes of extended-spectrumβ-lactamases（ESBLs）-producing pathogens causing respiratory tract infections in children so as to raise the effective rate of treatment.METHODS The ESBLs-producing pathogens were isolated from sputum specimens of 104 children with respiratory tract infections who were treated from Jun 2016 to Dec 2016,the drug resistance rates of the ESBLsproducing pathogens to the commonly used antibiotics were detected,and the drug resistance genes of the ESBLsproducing pathogens were analyzed by using PCR.RESULTS Totally 32 strains of ESBLs-producing pathogens were isolated from the 104 sputum specimens,including 14 strains of Klebsiella pneumoniae,14 strains of Escherichia coli and 4 strains of other species.The 32 strains of ESBLs-producing pathogens were highly resistant to cephalosporins,the drug resistance rates to cefazolin,cefuroxime and ceftriaxone were 100.00%,the drug resistance rate toβ-lactams/enzyme inhibitor compounds ranged between 21.88% and 34.38%,however,the drug resistance rate to carbapenems was 0%.The detection rates of CTX-M-9 strains was the highest（31.25%）,followed by the TEM strains（25.00%）;the OXA-10,CTX-M-2 or CTX-M-8 strains were not detected.CONCLUSIONThe ESBLs-producing pathogens isolated from the children with respiratory tract infections have the multidrug-resistant phenotypes characteristics and are highly resistant to cephalosporins,the strains are resistant to some of the enzyme inhibitor compounds and are highly susceptible to carbapenems.It is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing.