产超广谱β-内酰胺酶大肠埃希菌的医院感染临床分布与耐药性分析  

Clinical distribution and drug resistance of extended-spectrumβ-lactamases- producing Escherichia coli causing nosocomial infection

作　　者：顾萍[1] 袁咏梅[1] 邵苏吉[1] 许波银[1] 

机构地区：[1]南通大学附属医院感染管理办公室,江苏南通226001

出　　处：《中华医院感染学杂志》2013年第23期5823-5825,共3页Chinese Journal of Nosocomiology

基　　金：南通市指导性计划基金项目(2012HS12971)

摘　　要：目的探讨产超广谱B一内酰胺酶（ESBLs）大肠埃希菌的临床分布特征及耐药性，为临床合理使用抗感染药物和及早预防及控制医院感染提供科学依据。方法回顾性统计2007年1月-2009年12月分离的产ESBLs大肠埃希菌临床资料，进行医院感染临床分布与耐药性分析。结果3年中共检出大肠埃希菌178株，其中产ESBLs菌株119株，3年分离率分别为53．19％、69．35％、73．91％，呈逐年增长趋势；医院感染部位以下呼吸道为主占34．45％，其次为泌尿道占32．77％；科室的分布以ICU最高占21．01％，其次为神经内科占18．49％；产ESBLs大肠埃希菌株对20种抗菌药物呈现多药耐药，除对青霉素类的阿莫西林、哌拉西林、替卡西林及大部分头孢菌素100．00％耐药外，对环丙沙星耐药率为90．75％；对头孢哌酮／舒巴坦、庆大霉素、磺胺甲嗯唑／甲氧苄啶、妥布霉素、替卡西林／克拉维酸耐药率约68．00％～86．55％；对头孢西丁、阿莫西林／克拉维酸、哌拉西林／他唑巴坦、阿米卡星有较好的敏感性，耐药率均〈40．00％，未发现耐美罗培南、亚胺培南菌株。结论通过研究发现，产ESBLs大肠埃希菌耐药状况较严重，应采取有效的综合措施，预防和控制产ESBLs菌医院感染。OBJECTIVE To investigate the clinical distribution and drug resistance of extended-spectrum β-lactamas-es （ESBLs）-producing Escherichia coli so as to provide the scientific basis for rational clinical use of antibiotics as well as early prevention and control of nosocomial infection. METHODS The clinical data of the ESBLs-producing E. coli strains isolated from Jan 2007 to Dec 2009 were retrospectively analyzed, then the clinical distribution of the nosocomial infection sites and the drug resistance were observed. RESULTS During the three years, a total of 178 strains of E. coli have been isolated, among which there were 119 strains of ESBLs-producing strains, with the isolation rate of 53.19% in 2007, 69.35% in 2008, 73.91% in 2009, showing an upward trend. The lower respiratory tract （34. 45%） was dominant among the nosocomial infection sites, followed by the urinary tract （32.77%）% 21.01% of the strains were isolated from the ICU, 18. 49% from the neurology department. The ESBLs-produeing E. coli strains showed multiple drug resistance to 20 antibiotics, the drug resistance rates to the penicillins such as amoxicillin, piperacillin, and ticarcillin as well as most of the cephalosporins were 100.00%, the drug resistance rate to ciprofloxacin was 90.75%, the drug resistance rates to cefoperazone-sulbactam, genta-micin, sulfamethoxazole-trimethoprim, tobramycin, and ticareillin-clavulanic acid varied from 68. 00% to 68.55% while the strains were highly susceptible to cefoxitin, amoxicillin-clavulanic acid, piperacillin-tazobac-tam, and amikaein, with the drug resistance rates less than 40.00% no strains resistant to meropenem or imipen-cm were found. CONCLUSION This study concludes that the ESBLs-producing E. coli strains ate highly drug resistance, thus it is necessary to take effective intervention measures for the prevention and control of ESBL-producing E. coli infection.

关 键 词：大肠埃希菌 医院感染 临床分析 

分 类 号：R378.21[医药卫生—病原生物学]