大肠埃希菌和肺炎克雷伯菌门诊与住院患者分离菌株耐药性比较及临床意义  

Comparison of drug resistance in Escherichia coli and Klebsiella pneumoniae from outpatient and inpatient

作　　者：秦克秀[1] 俞凤[1] 李涛[2] 

机构地区：[1]安徽医科大学第一附属医院急诊内科,安徽合肥230022 [2]安徽医科大学第一附属医院检验科,安徽合肥230022

出　　处：《安徽医药》2009年第8期915-917,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的比较大肠埃希菌和肺炎克雷伯菌门诊与住院患者分离菌株耐药性的差异及临床意义。方法用MicroScan Walk-AWay-40全自动微生物分析仪鉴定细菌,用微量液体稀释法测定18种抗菌药物的耐药性,用NCCLS2004推荐的确证试验检测ES-BLs。结果住院患者分离大肠埃希菌对头孢唑啉、头孢噻吩、头孢呋肟、氨苄西林/舒巴坦、庆大霉素、头孢他啶、妥布霉素、头孢西丁、阿米卡星等抗菌药物耐药率显著高于门诊患者(P<0.05);住院患者分离肺炎克雷伯菌对氨苄西林/舒巴坦、哌拉西林、头孢唑啉、头孢噻吩、头孢呋肟、环丙沙星、复方新诺明、庆大霉素、头孢他啶、妥布霉素、氨曲南、头孢西丁、头孢曲松、头孢噻肟、阿米卡星、哌拉西林/他唑巴坦等抗菌药物的耐药率显著高于门诊患者(P<0.05);两种细菌住院患者分离菌株ESBLs菌株检出率均显著高于门诊患者(P<0.05)。结论社区感染菌株的药物敏感性较高,可用抗菌药物的范围较广,对门诊患者的治疗要选用不同与住院患者的抗菌治疗方案,尽量使用青霉素类或第一代、第二代头孢菌素,减少第三代头孢菌素和亚胺培南的使用。Aim To compare the difference of drug resistance in escherichia coli and klebsiella pneumoniae from outpatient and inpatient.Methods Bacteria were identified by MicroScan WalkAWay-40 and the drug resistance of Escherichia coli and Klebsiella pneumoniae against 18 antimicrobial agents were tested by micro-dilution method.Extended spectrum beta-lactamases（ESBLs） were confirmed by ceftazidime,ciftazidime-clavulanic acid and cefotaxime,cefotaxime-clavulanic acid according to NCCLS 2004.Results The drug resistance of E. coli against Cefazolin,Cephalothin,Cefuroxime,Ampicillin-sulbactam,Gentamicin, Ceftazidime,Tobramycin,Cefox- itin, Amikacin and K. pneumoniae against Ampicillin-sulbactam, Piperacillin, Cefazolin, Cephalothin, Cefuroxime, Ciprofloxacin, Trime- thoprim-Sulfamethoxazole, Gentamicin, Ceftazidime, Tobramycin, Aztreonam, Cefoxitin, Ceftriaxone, Cefotaxime, Amikacin, piperacillin- tazobactam was significant higher from inpatient than from outpatient. Incidences of ESBLs producing strains of E. coli and K. pneumoniae from inpatient were significant higher than from outpatient. Conclusions Antimicrobial agents susceptible of community infective strains is higher and we can use more antibacteria for infective therapy, so we should choose different herapeutic regimen from inpatient for outpatient, as far as possible use first and second generation cephalosporin and decrease third generation cephalosporin and impenem.

关 键 词：大肠埃希菌 肺炎克雷伯菌 耐药 抗菌药物 

分 类 号：R516[医药卫生—内科学] R446.5[医药卫生—临床医学]