革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)的检出率及其与细菌耐药性的关系

Relationship between the Detection Rate of Extended Spectrum β-lactamases(ESBLs) Produced by Gram Negative Bacilli and Bacterial Resistance

目的:结合临床实践经验,探讨革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)的发生率及其与细菌耐药性的关系。方法:对我院临床分离的革兰阴性杆菌,采用纸片扩散法检测产ESBLs菌株,对革兰阴性杆菌产ESBLs的分离率进行检测,通过革兰阴性杆菌药敏试验找出可能产生ESBLs菌株,分析其与细菌耐药性的关系。结果:732株临床检出率显示,共产ESBLs株224株,产ESBLs检出率30.60%。各菌株产ESBLs检出率差异有统计学意义(χ^2=8.162,P<0.05)。根据产生ESBLs菌株的多少,可由多到少排列为大肠埃希菌、肺炎克雷伯菌、变形杆菌、产酸克雷伯菌。经过比较,产ESBLs菌株检出率在各科室中差异有统计学意义(χ^2=19.863,P<0.05)。产ESBLs菌株在各科室分布前几个科室由多至少依次为重症监护室(占47.62%)、泌尿外科(占40.00%)、呼吸内科(占30.00%)、神经内科(占28.57%)。产ESBLs菌株对抗菌药物耐药率差异有统计学意义(χ^2=29.016,P<0.05)。产ESBLs菌株对抗菌药物耐药率差异有统计学意义(χ^2=29.016,P<0.05)。产ESBLs菌株耐药率较高的是青霉素类药物,而对碳青霉烯类药物呈高度敏感状态,其中耐药率排名前几位的是氨苄西林(98.21%)、丁胺卡那霉素(96.43%)、头孢唑啉(91.07%)、舒巴坦(67.86%)、环丙沙星(60.71%)。结论:本院产ESBLs菌检出率较高,主要以大肠埃希菌、产酸克雷伯菌、肺炎克雷伯菌为主。感染革兰阴性杆菌ESBLs的检出率高并呈多重耐药性,值得临床进一步研究。

Objective: To study the relationship between the incidence of ESBLs production by gram-negative bacilli and the bacterial resistance with clinical experience.Methods:For the gram-negative bacilli isolated in our hospital,the improved three-dimensional test was used to detect the esbls-producing strain,and the isolation rate of the ESBLs producing strain was tested.The drug sensitivity test of gram-positive bacilli was used to find out the possible drug production of the ESBLs strain,and the relationship between it and bacterial resistance was analyzed.Results:The clinical detection rate of 732 strains showed that 224 strains of Communist ESBLs,and the detection rate of ESBLs production was 30.60%.There was significant difference in ESBLs detection rate among strains(χ^2=8.162,P<0.05).According to the number of ESBLs producing strains,Escherichia coli,Klebsiella pneumoniae,Proteus and Klebsiella acidogenes can be arranged from more to less.After comparison,the detection rate of ESBLs producing strains in each department was statistically significant(χ^2=19.863,P<0.05).ESBLs producing strains were mainly distributed in ICU(47.62%),urology(40.00%),respiratory medicine(30.00%)and Neurology(28.57%).The difference of resistance rate of ESBLs producing strains to antibiotics was statistically significant(χ^2=29.016,P<0.05).The difference of resistance rate of ESBLs producing strains to antibiotics was statistically significant(χ^2=29.016,P<0.05).The resistance rate of ESBLs producing strains is higher than that of penicillins,but it is highly sensitive to carbapenems.Among them,ampicillin(98.21%),amikacin(96.43%),cefazolin(91.07%),sulbactam(67.86%)and ciprofloxacin(60.71%)are the top three.Conclusion:The detection rate of ESBLs producing bacteria was high in our hospital,mainly Escherichia coli,Klebsiella acidogenes and Klebsiella pneumoniae.The detection rate of ESBLs of gram-negative bacilli is high and it has multiple drug resistance.