广州地区医院感染大肠埃希菌及肺炎克雷伯菌耐药性监测分析  

Surveillance of Escherichia coliand Klebsiella pneumoniae isolates causing hospital-acquired infections in Guangzhou

作　　者：植志全[1] 卓超[2] 苏丹虹[3] 金光耀[2] 江广添 汤凤珍 

机构地区：[1]广州市花都区人民医院检验科,广东广州510800 [2]广州呼吸疾病研究所,广东广州510000 [3]广州医学院第一附属医院检验科,广东广州510120 [4]广州市花都区中医院检验科,广东广州510800

出　　处：《中华医院感染学杂志》2012年第9期1915-1917,共3页Chinese Journal of Nosocomiology

基　　金：广州市科技局科技攻关重大项目(2006z1-E0141)

摘　　要：目的调查广州地区医院感染大肠埃希菌和肺炎克雷伯菌及其耐药性。方法收集广州地区9所三甲医院和1所二甲医院2007年1月-2008年12月连续分离的引起医院感染非重复首次分离株,采用K-B法检测2种病原菌对抗菌药物的敏感性,采用WHONET-5.3软件进行统计分析。结果共收集大肠埃希菌4670株,肺炎克雷伯菌2801株,分别占医院感染菌株的14.2%和8.5%,ESBLs阳性率分别为45.7%和41.1%;大肠埃希菌检出率在尿标本最高占43.1%,其次是呼吸道标本占18.5%、伤口脓液及分泌物占14.6%、血液占10.2%等;肺炎克雷伯菌检出率在呼吸道标本最高占60.0%,其次是尿液占15.2%、伤口脓液及分泌物占8.8%、血液占7.6%等;大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南耐药率最低为0.5%～1.0%,其次为头孢哌酮/舒巴坦为4.8%和6.2%,对氟喹诺酮类在34.8%～70.2%;ESBLs阳性菌株对各检测药物耐药性均高于ESBLs阴性菌株。结论医院感染大肠埃希菌和肺炎克雷伯菌对碳青霉烯类保持高活性,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等含酶抑制剂复合制剂和阿米卡星耐受性低,须加强对地区细菌耐药性的检测,合理选用抗菌药物,控制细菌耐药性的产生和播散。OBJECTIVE To investigate the antimicrobial resistance among Escherichia coli and Klebsiella pneumoniae isolates causing hospital-acquired infections in Guangzhou.METHODS From Jan 2007 to Dec 2008,consecutive and non-repetitive bacteria were collected from 10 hospitals in Guangzhou,The susceptibility of antibacterial agents were determined by disk agar diffusion testing（Kirby-Bauer method,K-B）.Whonet 5.3 software was used to analyze the data.RESULTS A total of 4670（14.2%） E.coli isolates and 2801（8.5%） K.pneumoniae isolates were collected,the prevalence of extended-spectrum β-lactamases（ESBLs） were 45.7% and 41.1%,respectively.The constituent ratio of E.coli was the highest in urine（43.1%）,followed by sputum（18.5%）,wound（14.6%） and blood（10.2%）.Differently,the highest constituent ratio of K.pneumoniae was sputum（60.0%）,followed by urine（15.2%）,wound（8.8%） and blood（7.6%）.The resistant rates of E.coli and K.pneumoniae to imipenem and meropenem were the lowest,varying from 0.5% to 1.0%,the resistance rates to cefoperazone/sulbactam were 4.8% and 6.2%,cefotaxime,ceftazidime,and cefepime varying from 30.8% to 56.9%,fluoroquinolones varying from 34.8% to 70.2%;the resistance of ESBLs-positive strains to tested antibiotics was higher than that of ESBLs-negative strains.CONCLUSION Carbapenem antibiotics remain high antibacterial activity against E.coli and K.pneumoniae causing hospital-acquired infections which have low tolerance to the enzyme-containing inhibitor like cefoperazone/sulbactam,piperacillin/tazobactam and amikacin,it is necessary to strengthen the detection of drug resistance to reasonably choose antibiotics and control the occurrence and spread of bacterial resistance.

关 键 词：大肠埃希菌 肺炎克雷伯菌 医院感染 耐药性 

分 类 号：R378[医药卫生—病原生物学]