老年患者尿路感染产ESBLs大肠埃希菌和肺炎克雷伯菌的耐药性分析

Antibiotic resistance analysis of ESBLs-producing Escherichia coli and Klebsiella pneumoniae in urinary tract infections in elderly patients

目的了解老年患者尿路感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的耐药性,为临床合理用药提供依据。方法收集2015年1月~2017年12月于中国医科大学附属盛京医院就诊的老年尿路感染患者中段尿液标本进行细菌鉴定和药敏试验,将分离的1063株大肠埃希菌和202株肺炎克雷伯菌株进行ESBLs确证试验。结果3年内产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别是42.24%和38.61%,产ESBLs大肠埃希菌和肺炎克雷伯菌对大多数药物的耐药率高于非产ESBLs菌株。产ESBLs肺炎克雷伯菌对阿米卡星、呋喃妥因、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦等的耐药率(分别是14.10%、44.68%、24.36%、54.17%)明显高于产ESBLs大肠埃希菌(分别是4.23%、6.70%、2.46%、15.00%),差异有统计学意义(P<0.05)。结论产ESBLs大肠埃希菌和肺炎克雷伯菌的耐药性更加严重,临床上应根据药敏结果选择合适的抗菌药物。

Objective To investigate the drug resistance of extended spectrumβ-lactamases(ESBLs)producing Escherichia coli and Klebsiella pneumoniae in urinary tract infections in elderly patients so as to provide guidance for clinical rational use of antibiotics.Methods From January 2015 to December 2017,in Shengjing Hospital of Chinese Medical University,identification of bacteria and antibiotic susceptibility tests were performed on the strains isolated from the clean midstream urine specimens of elderly patients.ESBLs was detected by disk diffusion confirmatory test in the 1063 strains of Escherichia coli and 202 strains of Klebsiella pneumoniae.Results The detection rate of ESBLs-producing Escherichia coli and ESBLs-producing Klebsiella pneumoniae in three years was 42.24%and 38.61%respectively,and ESBLs-producing strains were more resistant to most drugs than non-ESBLs producing strains.The drug resistance rates of ESBL-producing Klebsiella pneumoniae to Amikacin,Nitrofurantoin,Piperacillin-tazobactam,Cefperazone-sulbactam(14.10%,44.68%,24.36%,54.17%respectively)were higher than ESBL-producing Escherichia coli(4.23%,6.70%,2.46%,15.00%respectively),and the differences were statistically significant(P<0.05).Conlusion The drug resistance of ESBLs-producing Escherichia coli and ESBLs-producing Klebsiella pneumoniae is more severe.So the antimicrobial agents should be chosen reasonably according to the results of the drug susceptibility.