摘要
[目的]了解本院产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌、大肠埃希菌分布及耐药特点。[方法]采用NCCLS推荐的纸片扩散法对我院从临床标本中分离的107株大肠埃希菌和95株肺炎克雷伯菌进行ESBL的确诊试验,并应用ATB G-5药敏卡对20种抗生素进行药敏试验。[结果]107株大肠埃希菌分离到产ESBLs菌株44株,检出率为41.12%,95株肺炎克雷伯菌分离到产ESBLs菌株35株,检出率为36.84%。ESBLs检出模式以单用头孢噻肟、头孢噻肟/棒酸一组为底物阳性率最高,分别占68.18%和62.85%;单用头孢他定,头孢他定/棒酸一组为底物,会造成大肠埃希菌68.18%和肺炎克雷伯菌62.85%的漏检。产ESBLs菌株对青霉素类、头孢菌素类的耐药率为55%～100%;但对哌拉西林/他唑巴坦的敏感率大于77%,对亚胺培南,美洛培南的敏感率均大于91%。[结论]本院分出的大肠埃希菌和肺炎克雷伯菌产ESBLs严重,且产ESBLs菌多呈多重耐药。建议各地根据感染菌株的特点及三代头孢菌素的使用情况,采用多种底物检测ESBLs。碳青酶烯类应作为治疗产ESBLs菌株的首选药物。
[Objective] To investigate the distribution and drug resistance characteristics of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-1actamases （ESBLs） in our hospital. [Methods] 107 strains of Escherichia coli and 95 strains of Klebsiella pneumoniae isolated from clinical samples were detected ESBLs-producing isolates by using double-disk diffusion tests which was recommended by NCCLS, and the susceptibility test was conducted by using ATB G-5 test strip. [Results] Among 107 strains of E.coli, 44 strains were found to be ESBLs positive, and the positive rate was 41.12%. 35 strains were found to be ESBLs positive among 95 strains of Klebsiella pneumoniae, the positive rate was 36.84%. Cefotaxim, Cefotsxim/Clavulanic Acid used for detection of ESBLs had the highest positive rate, which was 68.18% and 62,85% respectively. 68A8% E.coil and 62.85% Klebsiella pneumoniae would be missed if only Ceftazidime, Ceftazidime/ Clavulanic Acid used for detection. Nearly 55%-100% ESBLs-producing strains were resistant to Penicillins and Cephalosporins, but more than 77% strains were still susceptible to Piperacillin/Tazobactam, and above 91% stains were still susceptible to Imipenem and Meropenem. [Conclusions] The positive rate of Escherichia coli and Klebsiella pneumoniae producing ESBLs is high in our hospital, and the ESBLs-producing strains show multi-drug resistance. It is suggested that nulti-indicators for ESBLs detection should be applied in routine screening according to the characteristics of infected strains and the use of Third generation cephalosporin. The carbapenem antibiotics are choice drugs to dealwith ESBLs-producing strains.
出处
《现代预防医学》
CAS
北大核心
2007年第17期3270-3271,3274,共3页
Modern Preventive Medicine
基金
深圳市科技计划重大项目(JH200505260279A)
