产超广谱β-内酰胺酶菌感染患者并发真菌感染的分析  

Investigation on Double Infection of Extended-Spectrum β-Lactamase Bacteria and Eumycete

作　　者：李扬 林章礼 吴和顺[3] 郑婉君[2] 叶镇鹏 

机构地区：[1]广东省汕头市中医医院科教科,515031 [2]汕头市第二人民医院检验科,515031 [3]汕头市第二人民医院急诊科,515031 [4]广东省汕头市中医医院中医内科,515031

出　　处：《实用全科医学》2008年第4期361-362,共2页Applied Journal Of General Practice

摘　　要：目的了解产超广谱β-内酰胺酶（ESBLs）菌感染患者并发真菌二重感染情况及药敏情况，以指导临床合理使用抗生素。方法对2002-2006年我市某医院196例产ESBLs菌感染患者并发真菌二重感染进行回顾性研究。结果①产ESBLs菌感染患者并发真菌二重感染主要集中在ICU病房（53．6％）和呼吸内科（31．1％）；年龄主要分布在51～70岁（75．5％），平均62岁，男女之比约为2：1；感染标本以痰液为主（79．6％）。②产ESBLs菌主要为大肠埃希菌（43．9％）和肺炎克雷伯氏菌（41．8％）；产ESBLs菌耐药率为：氨苄西林、头孢他啶、哌拉西林和头孢噻肟四种抗生素全部耐药，复方新诺明（90．8％）、庆大霉素（77．6％）、环丙沙星（75．0％）、阿米卡星（69．4％）、阿莫西林＋棒酸（63．8％）、哌拉西林＋他唑巴坦44、4％、亚胺培南（3．1％）。③真菌药敏试验结果为：按敏感率从高到低排序，分别为氟康唑（95．92％）、两性霉素B（89．80％）、5．氟胞嘧啶（83．67％）、酮康唑（60．71％）、咪康唑（60．20％）。结论严格按照药物敏感试验合理使用抗生素是延缓细菌耐药性产生和减少产ESBLs菌感染及并发真菌二重感染的关键。Objective To investigate the double infection of Extended-Spectrum β-lactamase（ESBLs） bacteria and eumycete and their drug sensitivity in hope to guide the rational use of antibiotics in clinical practice. Methods The retrospective study on 196 cases with double infection of ESBLs bacterium and eumycete from 2002 to 2006 in a hospital in our city was made. Results The patients with double infection of ESBLs bacterium and eumycete were mainly in the ward of ICU（53.6% ） and respiratory medical department （31.1% ）. The age of patients were from 50 to 70 years old （average 62）. Ration of male to female was 2 ： 1. The infection sample was mainly sputum （ 79.6% ）. The bacteria that produce ESBLs were mainly Bacillus coli （43.9%） and Klebsiella pneumoniae （41.8%）. The eumycete was mainly Blastomyces albicans （70.9%）. Drug sensitive test shows that the rate of ESBLs bacteria resist against Ampicillin, Ceftazidime, Piperacillin and Cefotaxime was all 100%, whereas Bactrim（ 90. 8% ）, Cidomycin （77.6%）, Ciprofloxacin （75.0%）, Amikacin （69.4%）, Amoxicillin ＋ Clavulauic acid （63.8%）, Piperacillin ＋ Tazobactam（44.4% ） , Imipenem（ 3.1% ）. As to that of antifungal agent, Fluconazole （95.92%）, Amphotericin B （89.80%） ,5-Flucytosine（ 83.67% ） , Ketoconazole （60.71%） , Miconazole （60.20%）. Conclusions The reasonable use of antibiotics agent strictly according to the result of drug sensitive test can delay the drug-resistance process and decrease the double infection of producing ESBLs bacteria and eumycete.

关 键 词：超广谱 Β-内酰胺酶 真菌 二重感染 耐药分析 

分 类 号：R515[医药卫生—内科学] R519[医药卫生—临床医学]