产生超广谱β-内酰胺酶肺炎克雷伯菌的耐药性动态观察

Development observation of the resistance rates of extended-spectrum β-lactamases producing Klebsiella pneumoniae

目的 :分析本院 2 0 0 0年 1月至 2 0 0 2年 6月间产超广谱 β 内酰胺酶 (ESBLs)肺炎克雷伯菌耐药性的变化 ,为临床合理选用抗菌药物提供依据。方法 :采用K B纸片扩散法和ESBLs确证试验进行ESBLs的检测 ,数据输入WHONET5软件及SPSS10 .0软件进行统计分析。结果 :2 0 0 0年 1月至 2 0 0 2年 6月 ,本院所分离的 2 48株肺炎克雷伯菌中 ,产ESBLs的有 111株 ,占44 7% ;产ESBLs的肺炎克雷伯菌对青霉素类、头孢菌素类、单环 β内酰胺类、氨基糖苷类、喹诺酮类、以及加 β 内酰胺酶抑制剂复合剂 (如 :氨苄西林 舒巴坦、阿莫西林 克拉维酸、替卡西林 克拉维酸等抗菌药物 )呈多重耐药 ;显著高于非产ESBLs的肺炎克雷伯菌 (P <0 0 0 1) ;但对亚胺培南高度敏感。结论 :本院产ESBLs的肺炎克雷伯菌检出率高 ,临床治疗中应严格掌握抗菌药物应用指征 ,并动态监测其耐药性变迁 。

AIM: To investigate the trend of antibacterial resistance rate of extended-spectrum β-lactamases(ESBLs) producing Klebesiella pneumoniae in our hospital from January ,2000 to June ,2002 , for the guidance of rational use of antibacterials. METHODS: Antimicrobial susceptibility were tested by Kirby-Bauer agar diffusion method and ESBLs were detected by disc diffusion confirmatory test. WHONET5 software was used for data analysis and the SPSS 10.0 software was used to test Chi-Square test. RESULTS: One hundred and eleven strains of Klebesiella pneumoniae were considered extended-spectrum β-lactamases, detectable rates were 44.7%. The extended-spectrum β-lactamases-producing strains displayed multi-drug resistance to penicillins, cephalosporins, monobactams, amionglycosides, quinolones and ampicillin-sulbactam, amoxicillin-clavulanic acid, ticarcillin-clavulanic acid, etc. The resistance was significantly higher than that of extended-spectrum β-lactamases non-producing Klebesiella pneumoniae (P<0.001). But both of them were still highly sensitive to imipenem. CONCLUSION: The positive rates of extended-spectrum β-lactamases producing Klebesiella pneumoniae in our hospital was high and multi-drug resistance was serious. To prevent the ESBLs producing Klebesiella pneumoniae infection outbreak, more sputum culture and drug sensitivity should be emphasized before medication.