ICU产ESBLs革兰阴性杆菌的耐药性分析  

Drug-resistance of Gram-negative Bacilli Producing ESBLs in ICU

作　　者：洪文刚[1] 

机构地区：[1]武汉科技大学附属天佑医院病案统计室,武汉430064

出　　处：《西南军医》2014年第4期364-366,共3页Journal of Military Surgeon in Southwest China

摘　　要：目的：分析重症监护病房（ICU）产超广谱β内酰胺酶（ESBLs）革兰阴性杆菌的分布特点及其对抗菌药物的耐药性。方法选择2008年2月-2013年2月ICU临床分离的革兰阴性杆菌共325株，采用双纸片协同试验确诊产ESBLs阳性细菌，采用K-B法做药物敏感试验。结果325株革兰阴性杆菌中分离出产ESBLs菌71例（21.8%），依次为大肠埃希菌（38.9%）、肺炎克雷伯菌（37.7%）、阴沟肠杆菌（33.3%）和产气肠杆菌（20.0%）；71例产ESBLs革兰阴性杆菌主要从痰液（45例）和术后引流液（11例）中分离而来，痰液和术后引流液产ESBLs革兰阴性杆菌株分离率分别为16.2%、13.4%，明显高于尿液、血液及静脉导管的分离率，所致院内感染主要在下呼吸道和外科手术部位；药敏结果显示产ESBLs革兰阴性杆菌对亚胺培南高度敏感，而对绝大多数青霉素类和头孢菌素类抗生素呈耐药性表现。结论产ESBLs所致ICU院内感染现象较为严重，主要发生在下呼吸道和外科手术部位，仅对亚胺培南高度敏感，应根据药敏试验选择合适抗生素予以治疗。Objective To investigate the distribution of gram-negative bacilli producing extended spectrumβlactamases （ESBLs） in ICU and the resistance to antibiotics. Methods 325 strains of gram-negative bacilli were isolated from Feb., 2008 to Feb., 2013 in ICU;producing ESBLs positive bacteria were confirmed by double disk synergy test, and K-B method was applied in testing drug sensitivity. Results 71 strains of producing ESBLs bacilli were isolated from 325 strains of gram-negative bacilli （21.8%）, including Escherichia co-li （38.9%）, Klebsiella pneumoniae （37.7%）, Enterobacter cloacae （33.3%） and Enterobacter aerogenes （20.0%）;the 71 strains of produc-ing ESBLs bacilli were mainly isolated from sputum （45 cases） and postoperative drainage （11 cases）;the isolation rate of gram-nega-tive bacterial strain producing ESBLs in sputum and postoperative drainage fluid were 16.2%, 13.4% respectively, which were much higher than those in urine, blood and venous catheter;nosocomial infection mainly occurred in the lower respiratory tract and surgical operation sites;drug sensitivity test showed that gram negative bacilli producing ESBLs was highly sensitive to imipenem and held cer-tain resistance to the majority of penicillins and cephalosporins antibiotics. Conclusions Nosocomial infection in ICU induced by ES-BLs is a serious phenomenon, the occurrence mainly locates in the lower respiratory tract and surgical operation sites;it is highly sensi-tive to imipenem, and appropriate antibiotics should be selected in the treatment.

关 键 词：超广谱Β内酰胺酶 革兰阴性杆菌 重症监护病房 

分 类 号：R378.99[医药卫生—病原生物学]