克雷伯菌产超广谱β-内酰胺酶的检测及耐药性分析

Detection of Extended-spectrum Beta-lactamases and Analysis of Antibiotic Resistance in Clinical Isolates of Klebsiella

目的 监测克雷伯菌ESBLs的产生及其对常用抗生素的耐药性。方法 对广州市第一人民医院 2 0 0 0年～ 2 0 0 1年分离所得 2 0 7株克雷伯菌 ,采用标准纸片扩散确证法检测其ESBLs产生率 ,采用K B法进行药敏监测。结果 克雷伯菌产ESBLs率由 2 8%升高到 39%,产ESBLs株耐药性显著高于非产ESBLs株 ;产ESBLs株仅对四代头孢菌素、三代头孢菌素与 β 内酰胺酶抑制剂复合物、亚胺培南敏感 ,亚胺培南仍然为最有效的抗生素。结论 近年来克雷伯菌产ESBLs率显著升高 ;亚胺培南仍然为最有效的抗生素 ;应采取措施控制产ESBLs克雷伯菌感染。

OBJECTIVE To determine the antibiotic resistance and the productive rate of extended-spectrum-beta-lactamases (ESBLs) in the clinical isolates of Klebsiella. METHODS To detect the ESBLs and antibiotic resistance of Klebsiella, 207 strains of Klebsiella were isolated from the patients admitted to the Guangzhou First Municipal Hospital during the years 2000 and 2001, then antibiotic susceptibility test was peformed by Kirby-Baucer disk diffusion method, ESBLs production was performed by the standard disk diffusion method. RESULTS ESBLs productive rate increased significantly from 28% to 39% during the years 2000 and 2001. ESBLs-producing strains had higher resistance rate than that of non-ESBLs-producing ones. ESBLs-producing strains were only sensitive to the combination of third-generation cephalosporins with beta-lactamase inhibitor, fourth-generation cephalosporins and imipenem. Imipenem had the most effective antibiotic activity among them. CONCLUSIONS ESBLs production of Klebsiella had significantly increased. ESBLs-producing strains were the most sensitive to imipenem. Measures should be taken to control the spread of ESBLs-producing Klebsiella.