下呼吸道感染产超广谱β-内酰胺酶革兰阴性菌耐药性分析及临床意义  

Drug-resistance Analysis and Clinical Significance of Gram-negative Bacilli Producing Extended-spectrum β-Lactamases in Lower Respiratory Tract Infection

作　　者：李真[1] 戴丽[1] 张亚莲[1] 刘颖[1] 甄然[1] 

机构地区：[1]北京积水潭医院,北京100035

出　　处：《中华医院感染学杂志》2002年第1期13-15,共3页Chinese Journal of Nosocomiology

摘　　要：目的　分析下呼吸道感染产超广谱 β-内酰胺酶 (ESBL s)革兰阴性菌的产生及对 11种抗菌药物耐药情况 ,并对临床针对性治疗产 ESBL s耐药菌下呼吸道感染提出了建议。方法　采用法国生物 -梅里埃公司生产的 GNS-5 0 6药敏卡及双纸片协同试验法 ,对从临床下呼吸道感染标本中分离出的 16 6株革兰阴性菌作 ESBL s的检测 ,比较亚胺培南等 11种抗菌药物对产 ESBL s耐药菌体外抗菌作用。结果　产 ESBL s耐药株占全部分离菌的2 1.7% ,其中肺炎克雷伯菌占 36 .1% ,大肠埃希菌占 2 7.8% ,阴沟肠杆菌占 2 5 % ,铜绿假单胞菌占 8.3% ;亚胺培南对铜绿假单胞菌外产 ESBL s耐药菌均表现出最强抗菌作用 ;头孢西丁对产 ESBL s肺炎克雷伯菌及大肠埃希菌有较好的抗菌作用 ,其他产 ESBL s耐药菌对头孢西丁呈全部耐药 ;氨基糖苷类及氟喹诺酮类抗菌药物对产ESBL s肺炎克雷伯菌呈现出较好的抗菌作用。结论　产 ESBL s革兰阴性菌所致下呼吸道感染不容忽视 ;对产ESBL s革兰阴性菌下呼吸道感染的治疗 ,亚胺培南可作为首选药物。OBJECTIVE To analyse production of Gram negative bacilli producing extended spectrum β lactamases(ESBLs)which infected lower respiratory tract and drug resistance of ESBLs producing strains to 11 kinds of antibacterial drugs.Finally, a suggestion was given to treat lower respiratory tract infection(LRTI)due to drug resistance strains producing ESBLs.METHODS One hundred and Sixty six isolates from clinical lower respiratory tract infectious specimens were screened for the presence of ESBLs by the VITEK ESBL detection test and double disk synergy tests.In vitro antibacterial activity of 11 kinds of antibacterial drugs to strains producing ESBLs were compared .RESULTS In this sample, productive rate of ESBLs was 21.7%, and productive rate of ESBLs in Klebsiella pneumoniae, Escherichia coli,Enterobacter cloacae and Pseudomonas aeruginosa was 36.1%,27.8%,25% and 8.3%, respectively.Imipenem has the most powerful antibacterial activity to drug resistant strains producing ESBLs except P.aeruginosa. Cefoxitin has more antibacterial activity to K.pneumoniae and E.coli producing ESBLs.However,other strains producing ESBLs were all resistant to cefoxitin.Aminoglycosides and fluoroquinolones showed better activity to K.pneumoniae producing ESBLs. CONCLUSIONS LRTI due to Gram negative bacilli producing ESBLs could not neglected.Imipenem could be the first choice to treat LRTI due to drug resistant strains producing ESBLs.

关 键 词：下呼吸道感染 超广谱Β-内酰胺酶 ESBLS 革兰阴性菌 耐药性 

分 类 号：R56[医药卫生—呼吸系统] R969.4[医药卫生—内科学]