肺结核病人产超广谱β-内酰胺酶株感染及其耐药性的观察

ESBL infection and drug resistance in patients with pulmonary tuberculosis

目的 了解和比较肺结核病与非结核病患者产超广谱 β -内酰胺酶株 (ESBLs)的感染率和耐药性。方法 采用酶抑制剂增强纸片扩散法检测ESBLs株和SceptorPette系统测定细菌对 2 1种临床常用药物的敏感性。结果 肺结核病人的肺炎克雷伯氏菌中产ESBLs株为 39% ,大肠杆菌为78% ,较非结核病患者的ESBLs株感染率明显为高 ,后者ESBLs株感染率分别依次为 2 1%和 5 3%。上述产ESBLs株对头孢菌素第一、二代以及青霉素类、四环素类、磺胺类和喹诺酮类呈高度耐受性 ,仅有 4 1%～ 6 3%对氨曲南和第三代头孢菌素敏感 ,但对氨基糖苷类和碳青霉烯类有较高的敏感性。结论 超广谱 β -内酰胺酶是革兰阴性杆菌对第三代头孢菌素及单环 β -内酰胺类抗生素耐药的最重要机制 ,应高度重视产ESBLs株的检测和药物敏感性试验。

Objective To investigate and compare the infecton of extended spectrum beta lactamases (ESBLs) producing strains and their antibiotic resistance in patients with pulmonary tuberculosis and non pulmonary tuberculosis.Methods Inhi bitor potentioted disc diffusion test was used to determine the ESBLs producing strains and the Sceptor Pette system was used to test antibiotic susceptibility to 21 kinds of antibiotics applied clinically.Results The positive rate of ESBLs in Klebsiella Pneumoniae and Escherichia Coli was 39% and 78% in patients,which should that the rate in pulmonary was higher than the rate in non pulmonary tuberculosis.The later was only 21% and 53%,respectively.These ESBLs producing strains had hihger resistance rate to the 1st and the 2nd generation of Cephalosporin's,Penicillin's,Tetracycline's,Trime/sul and Quinollne's,while only 41% to 63% antibiotic susceptibility rate to Aztreonam and the 3nd generation of Cephalosporin's,but these strains had higher sensitivit to Amino glycosides.Conclusion ESBLs palys an important role in the mechanism of Gram negative bacterium antibiotics resistance to Cephalosporin's (3rd generation) and monocycle beta lactam antibiotics.Both the detecting of ESBLs producing strains and the testing of antibiotic susceptibility should be highly emphasized.