产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的分布及其耐药性研究  

Extended Spectum β-Lactamases Producing E.coli and K.pneumoniae:Their Distribution and Resistance to Antimicrobial Agent

作　　者：罗燕萍[1] 张秀菊[1] 徐雅萍[1] 田芳[1] 沈定霞[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《中华医院感染学杂志》2006年第1期101-104,共4页Chinese Journal of Nosocomiology

摘　　要：目的 了解我院产ESBLs肺炎克雷伯菌和大肠埃希菌的分布及不同来源的ESBLs耐药性。方法采用纸片扩散法进行药敏试验并应用WHONET5．3和EXCEL软件分析细菌分布和耐药性。结果我院产ESBLs的大肠埃希菌和肺炎克雷伯菌从1999年的14％和15％上升为2003年的30．1％和34．5％；产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌在血中分别为30．2％和30．4％；在21～30岁年龄组中肺炎克雷伯菌发生ESBLs最高占34．8％，产ESBLs大肠埃希菌在81～90岁年龄组中分离率最高为36．7％；门诊患者产ESBLs肺炎克雷伯菌和大肠埃希菌分别为19．8％和14．0％；住院患者产ESBLs肺炎克雷伯菌和大肠埃希菌分别为26．6％和31．6％，在住院患者中ICU的发生率最高为43．5％和52．4％；血液标本中大肠埃希菌一旦产生ESBLs与呼吸道标本和尿标本中产生的ESBLs大肠埃希菌对17种抗菌药物的耐药性差异无显著性；尿路标本中的ESBLs的肺炎克雷伯菌和大肠埃希菌除对头孢哌酮／舒巴坦（85．0％，65．2％）和哌拉西林／他唑巴坦（66．6%，29．4%）耐药性不同外，对其他抗菌药物的耐药率差别不大。结论肺炎克雷伯菌和大肠埃希菌的ESBLs发生率逐年增加，这些产ESBLs菌分布在不同病区的各种标本中，临床及时了解它们耐药特点和变化趋势对合理的应用抗菌药物十分重要。OBJECTIVE To investigate the prevalence and resistance of extended s pectram β-lactamases （ESBLs） producers in Escherichia coli and Klebsiella pneumoniae. METHODS ESBLs producing strains were screened by double disk test and confirmed by the NCCLS confirmatory test. Susceptibility test to antimicrobial agents was performed by disk diffusion method and analyzed by WHONET 5.3 and Excel. RESULTS The isolated ratio of ESBLs producing E. coli and K. pneumoniae increased from 14% and 15% in 1999 to 30.1% and 30.4% in 2002. Bacteremia caused by the two kinds of ESBLs producers accounted for 30.2% and 30.4%, respectively. ESBLs producing K. pneumoniae and ESBLs producing E. coli were 19.8% and 14.0% for outpatient and 26.6% and 31.60% for inpatient. The resistance of E. coli to 17 kinds of agents was similar, no matter it was isolated from blood, urine or sputum. Susceptibility of ESBLs producing E. coli and K. pneumoniae in urine to cefoperazone/ sulbactam, and piperacillin/tazobactam were 85% and 65.2%, 66.6% and 29.4%, although to other 15 agents there were no difference. None of the isolates showed resistance to imipenem. CONCLUSIONS There is an increasing trend of ESBLs producing E. coli and K. pneumoniae isolated from various kinds of specimens and from different wards. It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing E. coli and K. pneumoniae to antibiotics.

关 键 词：ESBLs肺炎克雷伯菌 ESBLs大肠埃希菌 分布 耐药性 

分 类 号：R969.3[医药卫生—药理学]