呼吸道感染患者产超广谱β-内酰胺酶大肠埃希菌、肺炎克雷伯菌检测及耐药性分析

The Detection and Drug Resistance Analysis of Escherichia Coli and Klebsiella Pneumoniae Producing Extended-spectrumβ-Lactamases in Patients with Respiratory Tract Infection

目的分析我院呼吸道感染患者产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、肺炎克雷伯菌耐药性、基因型。方法选择2017年5月至2018年6月间我院呼吸道感染患者痰培养标本分离的598株大肠埃希菌及肺炎克雷伯菌菌株作为研究样本,检测ESBLs菌株情况及耐药性,对50株ESBLs菌株进行耐药基因分型。结果598株大肠埃希菌及肺炎克雷伯菌检出产ESBLs菌株234株,检出率为39.13%,其中大肠埃希菌及肺炎克雷伯菌检出率分别为53.09%、29.57%;产ESBLs大肠埃希菌对亚胺培南药物敏感性最高,对哌拉西林、头孢唑啉药物敏感性最低,产ESBLs肺炎克雷伯菌对亚胺培南药物敏感性最高,对哌拉西林、复方新诺明药物敏感性最低;除亚胺培南、庆大霉素外,产ESBLs大肠埃希菌、肺炎克雷加伯菌对其他种类抗生素敏感性均显著低于非ESBLs菌株;50株ESBLs菌株中,CTX-M-13型菌株检出率最高(90.00%),TEM次之(80.00%),46株(92.00%)细菌携带多种基因。结论本院产ESBLs大肠埃希菌及肺炎克雷伯菌检出率较高,表现为多种抗生素耐药,且菌株多存在多种耐药基因。在临床治疗中宜选择亚胺培南及β-内酰胺酶抑制剂复方制剂等药物,同时也应增加耐药菌的监测。

Objective To analyze the drug resistance and genotypes of Escherichia coli and Klebsiella pneumoniae producing extended-spectrumβ-lactamases(ESBLs)in patients with respiratory tract infection in the hospital.Methods 598 strains of Escherichia coli and Klebsiella pneumoniae isolated from sputum culture specimens of patients with respiratory tract infection who were admitted to the hospital between May,2017 and June,2018 were selected as study samples.ESBLs strains and drug resistance were detected,and 50 ESBLs strains were subjected to drug resistance genotyping.Results 234 strains producing ESBLs were detected in 598 strains of Escherichia coli and Klebsiella pneumoniae,and the detection rate was 39.13%.The detection rates of Escherichia coli and Klebsiella pneumoniae were 53.09%and 29.57%,respectively.The sensitivity of Escherichia coli producing ESBLs to imipenem was the highest,while the sensitivities to piperacillin and cefazolin were the lowest.The sensitivity of Klebsiella pneumoniae producing ESBLs to imipenem was the highest,and the sensitivities to piperacillin and cotrimoxazole were the lowest.Except for imipenem and gentamicin,sensitivities of Escherichia coli and Klebsiella pneumoniae producing ESBLs to other types of antibiotics were significantly lower than those of non-ESBLs strains.Among 50 strains of ESBLs strains for genotyping,the detection rate of CTX-M-13 strains was the highest(90.00%),followed by TEM(80.00%).46 strains(92.00%)of bacteria carried multiple genotypes.Conclusion The detection rates of Escherichia coli and Klebsiella pneumoniae producing ESBLs in the hospital are high,which is characterized by multiple antibiotic resistances,and there are many drug resistance genes in these strains.For clinical treatment,it is advisable to choose drugs such as imipenem andβ-lactamase inhibitor compound preparations,and the monitoring system of drug-resistant bacteria should also be strengthened.