701株儿童感染大肠埃希菌的临床分布和耐药性分析  

Analysis the Distribution and the Resistance of 701 Escherichia Coli Strains in Children

作　　者：蒋鸿超[1] 黄海林[1] 奎莉越[1] 苏敏[1] 温柏平[1] 

机构地区：[1]昆明医科大学附属儿童医院,云南昆明650000

出　　处：《儿科药学杂志》2013年第12期38-40,共3页Journal of Pediatric Pharmacy

摘　　要：目的:了解儿童感染大肠埃希菌的临床分布及其对抗生素的敏感性情况,以指导临床合理使用抗菌药物。方法:对2009年1月至2013年5月我院儿童痰液、尿液、血液、分泌物等标本检出的701株大肠埃希菌,采用VITEK32全自动微生物鉴定药敏仪进行细菌鉴定,药敏测定采用K-B法,并比较不同标本所检出大肠埃希菌对抗菌药物的耐药性差异。结果:701株大肠埃希菌在临床检出标本中最常见为痰液标本356株(50.8%)、尿液标本252株(35.9%)、血液标本78株(11.1%)。药敏试验结果显示大肠埃希菌对亚胺培南和美罗培南最敏感,耐药率均为0.2%,其次为阿米卡星、呋喃妥因、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦,耐药率分别为7.3%、9.4%、22.1%、35.9%;对氨苄西林耐药率最高,为93.3%,其次是头孢菌素类,绝大部分耐药率高于75.0%。结果显示69.2%的大肠埃希菌为产超广谱β-内酰胺酶(ESBLs)大肠埃希菌。结论:大肠埃希菌在儿童感染中存在比较严重的耐药情况,但是儿童分离的产ESBLs大肠埃希菌对碳青霉烯类或加酶抑制剂复合抗菌药物仍较敏感,提示尽早进行细菌培养和耐药监测,可指导临床合理用药,避免产生更多耐药株。Objective： To investigate the distribution and antibiotic resistance of Escherichia coli in children in Kunming area in recent five years for the guidance of clinical treatment and prevention. Methods ： Seven hundreds and one samples from sputum, urine, blood and secretion were collected from January 2009 to May 2013 for bacterial identification by VITEK32 automatic system and antimicrobial susceptibility tests by Kirby-Bauer method. The drug resistance rate of E. coli isolated from different samples was compared. Results： Total 701 E. coli strains were collected. These isolates were collected from samples of sputum （356 strains, 50. 8% ）, urine （252 strains, 35.9% ） and blood （78 strains, 11. 1% ） and so on. The resistance rates to meropenem （0.2%） and imipenem （0.2%） were the lowest. The resistance rates to amikacin, nitrofurantoin, cefoperazone/sulbactam and piperacillin/tazobactam were very low （ account for 7.3% , 9.4% , 22.1% and 35.9% , respectively）. The results of antibiotic susceptibility test in vitro showed the general resistance to ampicillin was the highest （93.3%）. The resistance rates to cephalosporins took the second place （more than 75% ）. During the last five years, the detection rates of the ESBLs-producing E. coli was 69.2%. Conclusions： The situation on antibiotic resistance of E. coli from children becomes more and more severe. ESBLs-producing strains isolated from children are more sensitive to carbapenems and anti-microbial compound inhibitors. Therefore, it is urgent to strengthen the surveillance of antimicrobial susceptibility of E. coli and monitor drug-resistant strains timely to guide clinical treatment and prevention.

关 键 词：大肠埃希菌 耐药性 超广谱Β-内酰胺酶 儿童 

分 类 号：R725.1[医药卫生—儿科]