肝病患者腹腔感染病原菌大肠埃希菌和肺炎克雷伯菌耐药分析  

Analysis of drug-resistance of Escherichia coli and Klebsiella pneumoniae from ascites in patients with liver diseases

作　　者：秦恩强[1] 赵敏[1] 张昕[1] 王凝芳[1] 

机构地区：[1]解放军302医院感染一科,北京100039

出　　处：《中国现代医学杂志》2006年第14期2159-2160,2165,共3页China Journal of Modern Medicine

摘　　要：目的研究该院腹腔感染病原菌大肠埃希菌和肺炎克雷伯菌的耐药性,指导临床治疗。方法经腹水培养筛选出大肠埃希菌和肺炎克雷伯菌,检测ESBLs阳性菌株,采用Kirby-Bauer法检测病原耐药性。结果54株大肠埃希菌中,15株产ESBLs(29.3%);16株肺炎克雷伯菌中,2株产ESBLs(12.5%)。大肠埃希菌对左氧氟沙星耐药性高;产酶大肠埃希菌和肺炎克雷伯菌为多重耐药株,对亚胺培南、阿米卡星、头孢美唑敏感性高。结论腹腔感染的常见病原菌大肠埃希菌和肺炎克雷伯菌的耐药性仍在增高,第三代氟喹诺酮类药物不能作为一线用药,三代、四代头孢菌素仍可作为首选抗菌素,可同时加用β-内酰胺酶抑制剂提高疗效,亚胺培南可作为首选抗菌药物。[Objective] To study the drug-resistance of Escherichia coli and Klebsiella pneumoniae from ascites in patients with liver diseases so as to guide the clinical treatment. [Methods] Through the culture from ascites, strains of Escherichia coli and Klebsiella pneumoniae were found. ESBLs positive strains were detected. Kirby-Bauer method was used to detect the drug resistance rate. [Results] 15 strains（29.3%） were ESBLs positive among 54 strains of Escherichia coil 2 strains（12.5%） were ESBLs positive among 16 strains of Klebsiella pneumoniae. All strains of Escherichia coli had higher drug-resistivity to lev-ofloxacin. Producing ESBLs Escherichia coli and Klebsiella pneumoniae were multidrug-resistance strains, but had higher sensitivity to Imipenam, Amikacin and Cefmetazole. [Conclusion] The drug-resistance of Escherichia coli and Klebsiella pneumoniae in my hospital become higher. The Fluoroquinolones are not the first selective antibiotic to ascites infection. The third or fourth Cephalosporins can be the effective antibiotic, if β-1aetamase inhititors are added, their effect would be better. Imipenam is the most effective antibiotic.

关 键 词：肝病 大肠埃希菌和肺炎克雷伯菌 超广谱β-内酰胺酶(ESBLs) 

分 类 号：R378[医药卫生—病原生物学]