产ESBLs肺炎克雷伯菌和大肠埃希菌耐药性分析  

Drug-Resistance Analysis on ESBLs Producing Klebsiella Pneumonia and Escherichia Coli

作　　者：何晓雯[1] 王群兴[1] 周宜兰[2] 马芹[1] 曾一芹[2] 屈慧[2] 薛桂芹[1] 

机构地区：[1]三峡大学第一临床医学院,湖北宜昌443003 [2]宜昌市中心人民医院,湖北宜昌443003

出　　处：《医学新知》2006年第4期222-225,共4页New Medicine

摘　　要：目的探讨产超广谱β-内酰胺酶(extended spectrumβ-lactamase,ESBLs)肺炎克雷伯菌(KPN)、大肠埃希菌(ECO)的耐药性,为临床合理选用抗菌药物提供依据。方法采用双纸片协同初筛试验和确证试验对临床分离出的KPN98株和EC0280株进行ESBLs检测,并对产与非产ESBLs菌株的药敏试验数据进行统计分析。结果KPN中产ESBLs株占26．5％(26/98)、ECO中占45．0％(126/280)；其中以呼吸道标本最高,占61．84％。产酶株不仅对青霉素类、头孢菌素类、氨曲南耐药,而且对氨基糖苷类、喹诺酮类等抗菌药物呈多重交叉耐药,显著高于非产酶株(P＜0．001)；对阿莫西林/克拉维酸、头孢哌酮/舒巴坦的耐药率正在明显增高；所有菌株对亚胺培南均敏感。结论本院ECO和KPN的ESBLs发生率较高,临床应严格掌握抗菌药物应用指征,有必要监测其耐药性变迁,预防产ESBLs菌株所致感染的发生。Objective To investigate the antibacterial resistance rates of extendedspectrumβ-lactamases （ESBLs）, Klebsiella pneumonia and Escherichia coli based on the collected clinical specimens in our hospital during July 2004 to Feburary 2006 for the guidance on the rational usage of antibacterials. Methods Bacteria were screened for the presence of ESBLs under double-disk synergy test and confirmed by the method advised by NCCLS 2004. Antibiotic resistance of either ESBLs producing or non-producing strains was analyzed and studied retrospectively. Results 26 out of 98 strains of K.pneumonia were considered ESBLs and the positive rate was 26.5%. 126 out of 280 strains of E.coli were considered ESBLs and the positive rate was 45.0%, with the specimens of respiratory system having the highest, 61.84%. Antibiotic Resistance when compared to non-producing strains, the rates of the producing ones with ESBLs in all isolates were significantly higher than those of ESBLs non-producing strains （P〈0.001）. The antibiotic resistance of the producing strains was observed against not only penicil- lins, cephalosporins, and aztreonam, but also aminoglycosides, quinolones, and etc. The producing strains showed an increasing antibiotic resistance against amoxicillin/clavulanicacid, cefoerazone/sulbactam, and piperacllin-tazobactam. All the strains showed their sensitivity to imipenem. Conclusion The positive rates of ESBLs producing K.pneumoniae and E.coli in our area are high. In order to prevent the ESBLs producing K.pneumonia and E.coli infection, it is necessary that we closely monitor the strain antibiotic resistance changes and control the clinical dosage of antibiotics.

关 键 词：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]