小儿下呼吸道感染病原菌产超广谱β-内酰胺酶的检测分析  

Detection and Analysis of Bacteria Producing Extended Spectrum β-Lactamases in Children with Lower Respiratory Tract Infection

作　　者：杨善浦 董虹[2] 

机构地区：[1]浙江省玉环县人民医院儿科,浙江玉环县317600 [2]浙江省玉环县人民医院检验科,浙江玉环县317600

出　　处：《中华医院感染学杂志》2010年第23期3806-3808,共3页Chinese Journal of Nosocomiology

基　　金：玉环科技计划项目(200721)

摘　　要：目的调查分析小儿下呼吸道感染产超广谱β-内酰胺酶(ESBLs)病原菌的分布与耐药情况。方法收集医院2007年1月-2009年9月,确认为肺炎克雷伯菌和大肠埃希菌下呼吸道感染住院患儿痰标本148份,ESBLs采用双纸片扩散法检测,并做抗菌药物的耐药性分析。结果产ESBLs肺炎克雷伯菌和大肠埃希菌检出率分别为36.1%和31.4%,产ESBLs肺炎克雷伯菌和大肠埃希菌对多种抗菌药物的耐药率较非产酶株显著升高,其对阿莫西林、替卡西林、哌拉西林、头孢噻吩、头孢呋辛、头孢噻肟、头孢他啶和头孢吡肟耐药率均为100.0%,对碳青酶烯类(亚胺培南、美罗培南)敏感性最高(100.0%),对哌拉西林/他唑巴坦、阿米卡星、环丙沙星和头孢西丁的敏感性分别为100.0%和93.7%、94.3%和81.2%、91.4%和62.5%、82.9%和75.0%。其余抗菌药物有不同程度的耐药。结论产ESBLs肺炎克雷伯菌和大肠埃希菌在小儿下呼吸道感染中占重要地位,它对多种抗菌药物耐药,治疗产ESBLs菌感染首选碳青酶烯类抗菌药物。OBJECTIVE To investigate the distribution and resistance of extended spectrum β-lactamases（ESBLs） producing bacteria in children with lower respiratory tract infection.METHODS Totally 148 strains of Klebsiella pneumoniae and Escherichia coli were isolated from the sputum specimens which collected from lower respiratory tract infection of children in our hospital from Jan 2007 to Sep 2009.ESBLs-producing strains were detected and their susceptibilities to all antimicrobial agents were determined according to criteria of CLSI.RESULTS Among the isolated 51 strains of ESBLs-producing bacteria（34.5%）,35 strains were of K.pneumoniae（36.1%） and 16 strains of E.coli（31.4%）.The resistant rate of ESBLs-producing strains to most antibiotics was higher than that of non ESBLs-producing strains.The drug-resistance rates of ESBLs-producing strains against amoxicillin,ticarcillin,piperacillin,cefalothin,cefuroxime,cefotaxime,ceftazidime,and cefepime were 100.0%.To ESBLs-producing K.pneumoniae and E.coli,carbapenems（imipenem and meropenem） were the most active antimicrobial agents（all 100.0% susceptible）.The susceptibility of ESBLs-producing K.pneumoniae and E.coli to piperacillin-tazobactam,amikacin,ciprofloxacin and cefoxitin was 100.0% and 93.7%,94.3% and 81.2%,91.4% and 62.5%,82.9% and 75.0,respectively%.CONCLUSIONS ESBLs-producing K.pneumoniae and E.coli are important pathogenic bacteria in lower respiratory tract infections in children.There is a multi-drug resistance to the varied antibiotics.The first choice to treat ESBLs producting bacteria,is to select carbapenem antibiotics.

关 键 词：下呼吸道感染 超广谱Β-内酰胺酶 肺炎克雷伯菌 大肠埃希菌 耐药性 小儿 

分 类 号：R378[医药卫生—病原生物学]