产超广谱β-内酰胺酶菌株的监测及耐药性分析  

Extended-spectrum β-lactamases producing strains: monitoring and analysis of antibiotic resistance

作　　者：熊剑文[1] 裴云[1] 冯瑞祥[1] 李亚舒[1] 杨成芳[1] 

机构地区：[1]解放军第414医院检验科,江苏南京210015

出　　处：《南京军医学院学报》2003年第4期261-263,共3页Journal of Nanjing Military Medical College

摘　　要：目的:调查肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBL)菌株的耐药状况,并探讨对耐药菌感染的治疗策略。方法:收集2002年1月-2003年7月从送检的标本中分离出的肺炎克雷伯菌和大肠埃希菌136株,用表型确证试验检测ESBL,用Kirby—Bauer法作药敏试验。结果:筛选出产ESBL菌41株,检出率30.15％,其中肺炎克雷伯菌为36.96％,大肠埃希菌为26.67％;亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢西丁对产ESBL菌的耐药率最低,产ESBL菌对其他10种抗生素的耐药率明显高于非产ESBL菌。结论:治疗产ESBL菌引起的重症感染应首选碳青霉烯类抗生素亚胺培南,而β-内酰胺酶抑制剂与β-内酰胺酶类抗生素的复合制剂及头霉烯类抗生素也可作为选用药物.Objective:To investigate the antibiotic-resistance status of Klcbsiella pneumoniac and Eschmch-ia coli Extended-spectrum β-lactamases (ESBLs)stains and to explore the treatment strategy about the infection of drug-fast bacteria. Methods: The samples from which 136 strains of K. pneumonias and E. coli were isolated from January 2002 to July 2003. Phenotypic confirmatory test was used to detect ESBLs; Kirby-Bauer agar diffusion method was used for drug sensitive test. Results: Forty-one ESBL strains were produced, the detectable rate was 30.15%, among them, E. coli was 36.96% , and K. pneumonias was 26.67%. The drug resistant rates to ESBL-producing strains were the lowest in imipenem, cefoperazone-sulbactam, piperacillin-tazobactam and cefox-itin; the resistant rates of ESBL-producing strains to 10 other antibiotics were much higher than that of non-ESBL-producing strains. Conclusion: Imipenem is the first choice in the treatment of severe infection caused by ESBL-producing strains, while the combinations of β-lactam inhibitors and β-lactamas antibiotics as well as cephamycins can be used as alternatives.

关 键 词：产超广谱Β-内酰胺酶 肺炎克雷伯菌 大肠埃希菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]