超广谱β-内酰胺酶菌株的分布及耐药性分析  

Distribution of extended spectrum β-lactamase producing strains and their antibiotics resistance

作　　者：耿燕[1] 刘原[2] 张王刚[3] 王香玲[1] 李淑琴[1] 张毅[1] 

机构地区：[1]西安交通大学第二医院检验科,陕西西安710004 [2]西安交通大学第二医院呼吸科,陕西西安710004 [3]西安交通大学第二医院血液科,陕西西安710004

出　　处：《第四军医大学学报》2003年第13期1243-1245,共3页Journal of the Fourth Military Medical University

基　　金：陕西省科学技术研究发展计划项目 (2 0 0 2K1 0 G5)

摘　　要：目的 :明确本地区超广谱 β 内酰胺酶 (ESBL)菌株的分布特点及其耐药性 .方法 :对由ESBL菌引起的病例进行回顾性分析 ;采用全自动微生物分析仪Vitek进行肠杆菌科细菌的鉴定 ,ESBL的检测采用美国国家临床实验室NC CLS规定的ESBL型筛选和确定实验 ,用K B琼脂扩散法进行菌株的耐药性检测 .结果 :本地区肠杆菌科细菌中ESBL总阳性率为 15 .8% ,E .coli和K .pneu阳性率分别为 17.8%和 30 .9% ,ESBL菌以E .coli和K .pneu为主 ;192株ESBL菌中E .coli占 4 3.8% ,K .pneu占 36 .0 % ,E .cloa占 8.3% ;ESBL菌的分离率痰标本 2 0 .9%、其次为尿液 16 .3%、伤口分泌物 15 .1% ;ESBL菌多发生在呼吸科、老干部病房 ;药敏检测结果表明 ,亚胺培南和头孢哌酮 /舒巴坦对ESBLs菌均具有较强的杀菌活性 ,且亚胺培南优于头孢哌酮 /舒巴坦 ,但也出现了个别的耐药株 ;喹诺酮类和氨基糖甙类存在着不同程度的交叉耐药 .ESBL菌耐药性显著高于非ESBL菌 .结论 :E .coli和K .pneu是主要ESBL产生菌 ;ESBL菌多发生在呼吸道感染患者和泌尿系感染患者 ;碳青霉烯类和加酶抑制剂复合物对ESBL菌具有显著的抗菌活性 。AIM: To study the distribution of extended spectrum β lactamase (ESBL) producing strains and their antibiotics resistance. METHODS: Automatic microbial system (Vitek) was employed for the identification of Enterobacteriaceae, disk diffusion confirmatory test for the detection of ESBL and K B disk diffusion (in accordance with the NCCLS standards) for drug susceptibility test. Clinical cases were investigated retrospectively. RESULTS: Of the 1212 strains isolated from 5 clinical laboratories, 192 (15.8%) were designated ESBL producing bacteria in Enterbacteriaceae. The positive rates of ESBL of E. coli , and K. pneu were 17.8% and 30.9% respectively. E. coli accounted for 43.8% of the bacteria, followed by K. pneu (36.0%) and E. cloa (8.3%). The most common sources of ESBL producing strains were respiratory tract (20.9%), urinary tract (16.3%) and wound secretion (15.1%). The rate of antibiotics resistance to Imipenem and cefosperazone/Sulbactam were 4.6% and 7.6% respectively. The difference of drug resistant rates between ESBL positive strains and ESBL negative strains was significant. CONCLUSION : E. coli and K. pneu are the two most common bacteria producing ESBL, the most common infection sites being respiratory tract and urinary tract. ESBL producing strains are more resistant to β lactamase antibiotics than ESBL negative strains. The best antibiotics for the treatment of ESBLs positive strains are Imipenem and cefosperazone/Sulbactam. It is suggested that the detection of ESBLs strains is of practical value in the rational use of antibiotics.

关 键 词：超广谱Β-内酰胺酶 分布特点 耐药性 临床实验 菌株 

分 类 号：R37[医药卫生—病原生物学]