产超广谱β-内酰胺酶菌的检出情况及耐药性分析  

Circumstances of detection for producing extended-spectrum 15-1actamases bacteria and drug resistance analysis

作　　者：李爱华 

机构地区：[1]阳江市人民医院检验科,广东阳江529500

出　　处：《医学检验与临床》2016年第4期35-37,63,共4页Medical Laboratory Science and Clinics

摘　　要：目的：研究临床不同标本中产超广谱β-内酰胺酶（ESBLs）菌的检出情况及耐药特点，以指导临床合理用药。方法：采用法国生物梅里埃公司的VITEK-2微生物自动鉴定系统，对我院2014年至2016年1月的各类临床标本进行细菌鉴定和药敏试验。采用K-B纸片琼脂扩散法检测12种抗生素的敏感性，并对药敏结果进行分析。结果：62764份临床标本中，病原菌中产ESBLs的有724株，阳性率为1．15％，其中，大肠埃希菌542株，占74．87％，其次为肺炎克雷伯菌134株，占18．51％，第三为奇异变形杆菌29株，占4．01％，其它菌株其48株，占6．63％。产ESBLs菌科室中，以泌尿科检出最多，为179株（其中145株为大肠埃希菌），其次为综合外科，检出78株（其中66株大肠埃希菌），第三为重症监护病区，检出55株（其中35株为大肠埃希菌）。产ESBLs菌为多重耐药菌，其中产ESBLs大肠埃希菌和肺炎克雷伯菌对青霉素类、第一、二、三代头孢菌素类的耐药率均在85％以上，产ESBLs奇异变形杆菌对青霉素类、第一、二代头孢菌素类的耐药率在80％以上，碳青霉烯类对上述菌株仍保持较高的抗菌效果。结论：目前我院产超广谱β-内酰胺酶菌主要为大肠埃希菌和肺炎克雷伯杆菌，产ESBLs菌对多种抗菌药物均出现不同程度的耐药性，碳青霉烯类抗菌药物仍保持较高的敏感性。Objective： The present study aims to investigate the detection and drag resistance of bacteria producing extended spectrum β-lactamase to guide clinical drag usage. Methods： The bacteria was indentificaed and drug sensitivity tested of our hospital from 2014 to 2016 by Merieux Vitek-2 automatic microorganism identification system. 12 kinds of antibiotic sensitivity was tested by K-B disc agar diffusion method. Results： 724 pathogenic bacteria producing ESBLs was isolated from 62764 chnical specimens, and the positive rate was 1.15%. Among them, 542 strains of Klebsiella pneumonias, accounting for 74.87%; 134 strains of Klebsiella pneumonias, accounting for 18.51%; 29 strains of singular proteus accounting for 4.01%, Among the ESBLs producing strains, 179 for strains are from urology, followed by general surgical （78 strains） , and 55 strains are from ICU. Bacteria ESBLs are multi drug resistant bacteria, The drug resistant rate of E. coli and Klebsiella pneumonia to penicillin and cephalosporin was above 85% ESBLs producing singular deformation bacilli resistant to penicillin and cephalosporin was above 80%. Carbapenems on the above strains remained high antibacterial effect. Conclusion： The extended spectrum beta lactamases produced in our hospital - lactamase mainly Klebsiella pneumonia and Escherichia coil, ESBLs producing bacteria to many antimicrobial agents showed different degrees of resistance and carbapenem antibiotics remained higher sensitivity.

关 键 词：大肠埃希菌 肺炎克雷伯菌 奇异变形杆菌 产超广谱Β-内酰胺酶 耐药性 

分 类 号：R978.11[医药卫生—药品]