超广谱β-内酰胺酶细菌下呼吸道感染的监测及危险因素分析  

Surveillance of Lower Respiratory Tract Infection of ESBL-producing Strains and Analysis of Risk Factors for Acquisition

作　　者：穆新林[1] 何礼贤[2] 周昭彦[2] 周春妹[2] 贾漫林[2] 倪才妹[2] 胡必杰[2] 瞿介明[2] 

机构地区：[1]蚌埠医学院附属医院,安徽蚌埠233004 [2]复旦大学呼吸病研究所,上海200032

出　　处：《中华医院感染学杂志》2002年第2期94-96,共3页Chinese Journal of Nosocomiology

摘　　要：目的　了解下呼吸道标本中产超广谱 β-内酰胺酶 (ESBL)菌检出情况及下呼吸道产 ESBL 菌感染的危险因素。方法　收集下呼吸道标本中分离出的肺炎克雷伯菌及大肠埃希菌 ,微量稀释法检测细菌药敏情况 ,双纸片试验检测产 ESBL 菌 ,等电聚焦电泳测定 β-内酰胺酶的等电点 ;用 L ogistic多因素回归分析研究产 ESBL 菌感染的危险因素。结果　 1998年 3～ 10月共分离出肺炎克雷伯菌 12 6株、大肠埃希菌 2 9株 ,39株产 ESBL 菌均为肺炎克雷伯菌 (31% ) ,其中 33株产 1种 β-内酰胺酶 ,6株产 2种酶 ,以 p I7.6的 β-内酰胺酶为主 ,其次是 p I8.2的酶 ;药敏结果显示产 ESBL 菌对 11种抗生素的耐药率均显著高于非产 ESBL 菌 ;L ogistic多因素回归分析表明先期使用第三代头孢菌素、入住 ICU的相对危险度分别为 3.6 2和 6 .0 9。结论　上海中山医院下呼吸道标本肺炎克雷伯菌中产 ESBL 菌的检出率较高 ,以 SHV型 ESBL 为主 ;先期使用第三代头孢菌素、入住 ICU是下呼吸道产 ESBLOBJECTIVE To detect the ESBL-producing strains from lower respiratory tract samples and identify the risk factor of ESBL-producing strains infection. METHODS Klebsiella pneumoniae and Escherichia coli were collected from lower respiratory tract samples. Microdilution method was used for antimicrobial susceptibility test. Double-disk synergy test was used to detect ESBL-producing strain, and the pI of β-lactamase was identified by isoelectric focusing. Risk factors of ESBL-producing strain infection were analysed with Logistic regression. RESULTS From Mar. 1998 to Oct. 1998, 126 strains of K.pneumoniae and 29 E.coli were isolated from lower respiratory tract samples. All the 39 ESBL-producing strains were strains of K.pneumoniae. Thirty three ESBL-producing strains produced one kind of β-lactamase, six strains produced two different β-lactamases. The β-lactamase of pI 7.6 was the major enzyme followed by β-lactamase of pI 8.2. The resistant rate of ESBL-producing strains to 11 antibacterial agents was significantly higher than that of non ESBL-producing strains. Relative risk of previous use of the third generation of cephalosporins and admission to ICU were 3.26 and 6.09, respectively. CONCLUSIONS Isolation rate of ESBL-producing K.pneumoniae from lower respitatory tract was high in the hospital and the major ESBL was SHV type. ESBL-producing strain acquisition depends on previous use of the third generation of cephalosporins and admission to ICU.

关 键 词：下呼吸道 超广谱Β-内酰胺酶 肺炎克雷伯菌 大肠埃希菌 肺炎 危险因素 监测 

分 类 号：R563.1[医药卫生—呼吸系统]