新生儿呼吸道感染产超广谱β-内酰胺酶菌的菌群分布及耐药性分析  

Bacteria distribution and antibiotic resistance of extended spectrum β-lactamases in neonates with respiratory tract infection

作　　者：贺潇[1] 申燕[1] 钟文 谢茜[2] 李秋红[1] HE Xiao;SHEN Yan;ZHONG Wen;XIE Qian;LI Qiuhong(Departmen of Clinical Laboratory,Chongqing Health Center for Women and Children,Chongqing,400013,China;Department of Neonatology,Chongqing Health Center for Women and Children,Chongqing,400013,China)

机构地区：[1]重庆市妇幼保健院检验科,重庆400013 [2]重庆市妇幼保健院新生儿科,重庆400013

出　　处：《国际检验医学杂志》2019年第10期1205-1208,1212,共5页International Journal of Laboratory Medicine

基　　金：重庆市卫生健康委员会医学科研项目(2012-2-208)

摘　　要：目的探讨新生儿呼吸道产超广谱β-内酰胺酶(ESBLs)菌的菌群分布及其耐药情况,指导临床合理用药。方法收集2013年1月至2018年9月分离自该院新生儿科患儿呼吸道的产ESBLs菌和非产ESBLs菌,采用肉汤法进行药敏试验。结果新生儿呼吸道感染产ESBLs菌中肺炎克雷伯菌占72.73%,大肠埃希菌占27.27%,二者的ESBLs检出率分别为48.24%和28.12%。产ESBLs菌对部分抗菌药物耐药率明显高于非产ESBLs株,差异有统计学意义(P<0.05)。对添加β-内酰胺酶抑制剂而言,产ESBLs肺炎克雷伯菌对阿莫西林/克拉维酸、氨苄西林/舒巴坦和哌拉西林/他唑巴坦的耐药率分别为29.17%、90.63%和57.29%;而产ESBLs大肠埃希菌的耐药率分别为8.33%、38.89%和2.78%。产ESBLs肺炎克雷伯菌和大肠埃希菌的多重耐药率分别为97.92%和88.89%。结论新生儿呼吸道感染中产ESBLs菌检出率较高,且新生儿呼吸道产ESBLs菌的多重耐药率高于成人。体外抗菌试验结果显示对导致新生儿呼吸道感染的产ESBLs菌,不同含β-内酰胺酶抑制剂的复合β-内酰胺类抗菌药物其耐药率有差别,将对指导临床合理用药具有积极的意义。Objective To study the distribution characteristics and antibiotic resistance of extended spectrum β-lactamases (ESBLs) in neonates with respiratory tract infection,in order to guide rational antibacterial therapy.Methods The ESBLs-producing bacteria and non ESBLs-producing bacteria of respiratory tract infection separated from Department of Neonatology of the hospital from January 2013 to September 2018 were collected to conduct drug sensitive test by broth dilution method.Results Among the ESBLs-producing bacteria with neonatal respiratory infection,Klebsiella pneumoniae accounted for 72.73%,Escherichia coli 27.27%.The detection rates of ESBLs in Klebsiella pneumoniae and Escherichia coli were 48.24% and 28.12%,respectively.The resistant rate of ESBLs-producing bacteria to some antimicrobial agents were significantly higher than that of non-ESBLs-producing bacteria,with statistically significant difference(P<0.05).The resistant rate of ESBLs-producing Klebsiella pneumoniae to Amoxicillin-clavulanic,ampicillin-shubatan or piperacillin-tazobactam were 29.17%,90.63% and 57.29% respectively,while the resistant rates of ESBLs-producing Escherichia coli were 8.33%,38.89% and 2.78% respectively.The multiple antibiotic resistance rates of the ESBLs-producing Klebsiella pneumoniae and the ESBLs-producin Escherichia coli were 97.92% and 88.89%,respectively.Conclusion Detection rate of ESBLs-producing strains is high in respiratory tract infections of neonates,and the multiple antibiotic resistance rates of the ESBLs-producing bacteria causes neonatal respiratory tract are higher than those in adults.Antimicrobial test in vitro shows that the resistance rates of different combinations of beta-lactams and beta- lactamase inhibitors are differently in neonatal respiratory tract,which will be positive significance in guiding the clinical administration of drugs.

关 键 词：Β内酰胺酶类 婴儿 新生 呼吸道感染 抗药性 微生物 微生物敏感性试验 

分 类 号：R722.13[医药卫生—儿科] R446.5[医药卫生—临床医学]