血培养中产超广谱β-内酰胺酶大肠埃希杆菌与肺炎克雷伯杆菌临床分布及耐药性分析  

Drug resistance and clinical distribution of ESBLs^+ Escherichia coli and Klebsiella pneumoniae strains from culturing blood samples

作　　者：查干[1] 李瑞婷[2] 王文[1] 李瑞云[1] 金松[1] 王勋[1] 李春年[1] 吴小军[1] 

机构地区：[1]武汉大学人民医院呼吸内科,430060 [2]武汉大学中南医院呼吸内科

出　　处：《疑难病杂志》2017年第3期234-238,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省卫生和计划生育委员会项目资助(sj-201209)

摘　　要：目的分析血培养中产超广谱β-内酰胺酶(ESBLs)大肠埃希杆菌及肺炎克雷伯杆菌临床分布及耐药性。方法 2012年10月—2015年9月武汉大学人民医院送检血培养阳性的标本中分离大肠埃希杆菌和肺炎克雷伯杆菌,均采用BACTEC-FX BD全自动血培养仪进行血培养,阳性标本用BD全自动微生物鉴定/药敏仪Phoenix-100进行鉴定,应用WHONET5.5软件进行抗生素耐药性分析。结果临床血培养标本共检出肠杆菌科921株,包括大肠埃希杆菌487株(52.88%)及肺炎克雷伯杆菌184株(19.98%),其中产ESBLs大肠埃希杆菌314株(64.48%)和肺炎克雷伯杆菌184株(32.61%)。产ESBLs大肠杆菌及肺炎克雷伯杆菌对青霉素类、头孢类、喹诺酮类、红霉素类等抗菌药表现出高的耐药性(62.1%~100%),阿米卡星(5.2%)及派拉西林/他唑巴坦(10.3%)表现出有良好的抗菌作用,美洛培南(0.9%)、亚胺培南(0)碳青酶希类等抗菌药效果最好。血培养中产ESBLs菌株对各种抗菌药(除美罗培南与亚胺培南)的耐药率明显高于不产ESBLs菌株,差异有统计学意义(P<0.05)。结论血培养中产ESBLs大肠埃希杆菌与肺炎克雷伯杆菌对各类抗菌药物呈现不同程度耐药,并具多重耐药特点,碳青霉烯类亚胺培南和美罗培南仍是最敏感抗产ESBLs菌的药物,阿米卡星和哌拉西林/他唑巴坦亦保持了良好的抗菌活性。应加强产ESBLs菌株的监测及耐药性分析,以指导临床合理用药,并对控制产ESBLs菌株的播散以及耐药基因的传播具有重要意义。Objective To provide the evidence for treatment of Escherichia coli and Klebsiella pneumoniae infection by investigating its distribution and drug resistance from culturing blood samples.Methods Nine hundred and twenty-one strain of enterobacteriaceae including 487 Escherichia coli and 184 Klebsiella pneumoniae strains isolated from October 2012 to September 2015,all used BACTEC FX BD automatic blood culture system for culturing blood samples,the pathogens identification and resistance test were carried out by automatic microorganism identification instrument（Phoenix 100 BD）,and their drug resistance was analyzed by WHONET 5.5 software.Results 2 063 pathogenic strains were detected,921 strains of enterobacteriaceae,including 487 Escherichia coli（52.88%） and 184 pneumonia Klebsiella strains（19.98%）,and the detection rate of ESBLs^＋ Escherichia coli and pneumonia Klebsiella pneumoniae were 64.48%and 32.61%.The drug resistance of ESBLs~＋ Escherichia coli and pneumonia Klebsiella pneumoniae was from 62.1%to 100%to penicillins,cephalosporins,quinolones,and erythromycin and so on.However,the other drug resistance;amikacin（5.2%） and piperacillin/tazobactam（10.3%） have good antibacterial effects;Carbon black enzymes such as meropenem（0.9%） and imipenem（0） were the most sensitive antibacterial drug.The drug resistance rate of ESBLs~＋ strain of various antimicrobials（with the exception of Imipenem and meropenem） in blood culture was higher than that of ESBLs,and the difference was statistically significant（P〈0.05）.Conclusion ESBLs^＋ Escherichia coli and pneumoniae in culturing blood for all kinds of antibacterial drugs showed different degrees of resistance,and multi drug resistance,carbapenems including imipenem and meropenem is still the most sensitive anti ESBLs^＋ bacteria drug;amikacin and piperacillin/tazobactam also guarantees to good antibacterial effect.Monitoring and drug resistance analysis of ESBLs^＋ strains should be strengthened to guide clinical rational drug

关 键 词：血培养 大肠埃希杆菌 肺炎克雷伯杆菌 超广谱Β-内酰胺酶 耐药性 

分 类 号：R446.5[医药卫生—诊断学]