铜陵地区产ESBLs大肠埃希菌、肺炎克雷伯菌的检测及耐药性分析

目的了解本地区医院分离出的产超广谱产β-内酰胺酶(ESBLs)的大肠埃希菌、肺炎克雷伯菌菌株的构成比及耐药特征,为临床制定合理的抗感染治疗方案提供参考。方法2003年10月1日至2004年9月30日从本地区五家医院各类临床标本分离的大肠埃希菌、肺炎克雷伯菌作为受试菌,采用Kirby-Bauer纸片扩散法和ESBLs确认试验进行ESBLs的检测及耐药性测定。结果产ESBLs的大肠埃希菌检出率为31%,肺炎克雷伯菌为31.6%,产ESBLs的大肠埃希菌及肺炎克雷伯菌株较不产ESBLs的菌株对各种临床常用抗生素耐药性明显增高,并表现出多重耐药。产ESBLs的大肠埃希菌及肺炎克雷伯菌株对临床常用的头孢呋辛、头孢噻肟、头孢哌酮、头孢曲松、氨曲南、阿莫西林/克拉维酸、替卡西林/克拉维酸、氨苄西林/舒巴坦的耐药率均超过70%,对头孢哌酮/舒巴坦的耐药率在50%左右,对氟喹诺酮类的耐药率在41.7%～72.7%,未发现对亚胺培南的耐药株。结论产ESBLs大肠埃希菌和肺炎克雷伯菌如此高的检出率应引起临床上高度重视,碳青霉烯类抗生素应该作为治疗产ESBLs菌严重感染的首选药物。

Detection and antibiotic - resistance analysis of ESBLs - producing bacteria - Escherichia coli and Klebsiella pneumoniae in Tongling

Objective To survey constituent ratio and durg-resistance characteristics of ESBLs-producing bacteria-Escherichia coli and Klebsiella Pneumoniae.Methods Detection and durg-sensitivity tests to ESBLs-producing bacteria-Escherichia coli and Klebsiella pneumoniae by kirby-bauer method and confirmation tests.The strains was collected from five hospitals in Tongling city from October 2003 to September 2004.Results The constituent ratio of Escherichia coli and Klebsiella pneumoniae which could produce ESBLs were 31% and 31.6%.The MDR(multi-durg-resistance) rate of ESBLs-producing strains was higher than that of no producing ESBLs.The resistance rate of ESBLs-producing Escherichia coli and Klebsiella pneumoniae to Cefuroxime,Cefotaxime,Cefoperazone,Ticacillin/Clavulanete Potassium,Cefotriaxon,Aztreonam,Augmentin,Sulbactam/Ampicillin over 70%.It is about 50% to Cefoperazone/Sulbactam and 41.7～72.7% to Fluoroquinolones.All of the ESBLs-producing strains of Escherichia coli and Klebsiella pneumoniae were sensitive to Imipenem.Conclusions The high constituent ratio of ESBLs-producing bacteria-Escherichia coli and Klebsiella pneumoniae should be regarded in clinical.Imipenem could be the first choice to treat the serious infection caused by ESBLs-producing strains.