福州地区肺炎克雷伯氏菌和大肠埃希氏菌的药敏监测

目的监测福州地区肺炎克雷伯氏菌和大肠埃希氏菌对14种常用抗生素的药敏情况，为临床合理选用抗生素提供依据。方法收集2001年3月-10月福州地区4家医院分离的肺炎克雷伯氏菌和大肠埃希氏菌426株，用K-B琼脂扩散法作药敏试验；用表型确认试验检测超广谱β-内酰胺酶(ESBLs)。结果在14种抗生素中，敏感性最高的是亚胺培南(100％)、头孢哌酮／舒巴坦(100％)、哌拉西林／三唑巴坦(99．53％)、头孢吡肟(94．37％)和头孢美唑(91．08％)，敏感性最低的是阿莫西林(12．68％)、哌拉西林(48．83％)和环丙沙星(50．70％)；除头孢他啶外，第三代头孢菌素对肺炎克雷伯氏菌和大肠埃希氏菌的耐药率均在30％以上；产ESBLs菌检出率为33．33％(142／426)；除亚胺培南、头孢哌酮／舒巴坦、哌拉西林／三唑巴坦和头孢美唑外，产ESBLs菌对其它10种抗生素的耐药率均显著高于非产ESBLs菌。结论亚胺培南、头孢哌酮／舒巴坦、哌拉西林／三唑巴坦、头孢吡肟和头孢美唑的敏感性最高，产ESBLs是肺炎克雷伯氏菌和大肠埃希氏菌产生耐药的主要机制之一，临床实验室有必要常规检测肺炎克雷伯氏菌和大肠埃希氏菌是否产ESBLs。

Resistant rates of clinical isolate of Klebsiella pneumoniae and Escherichia coli in Fuzhou

Objective To investigate the resistant rates of Klebsiella pneumoniae and Escherichia coli strains to 14 antibiotics in Fuzhou. Methods K-B agar dif fusion method was used to determine the drug sensitivity; phenotypic confirmator y test was used to detect ESBLs in 426 strains of Klebsiella pneumoniae and Esch erichia coli. Results In 14 antibiotics,imipinem,cefoperazone/sulbactam,piperaci llin/tazobactam, cefepime,and cefmetazole had the highest susceptible rates of 1 00%,100%,99.53%,94.37 and 91.08%,respectively.Amoxicillin,piperacillin and c iprofloxacin had the lowest sensitivity rates of 12.68%,48.83%and 50.70%,resp ectively. Except ceftazidime,the resistant rates of Klebsiella pneumoniae and Es cherichi a coli strains to the third Cephlosporins were more than 30%.33.33%of strains were identified with ESBLs producers by phenotypic confirmatory test.Except imip inem,cefoperazone/sulbactam,piperacillin/tazobactam and cefmetazole,the resistan t rates of ESBLs-producing strains to other 10 antibiotics were much higher tha n those of non-ESBL-producing strains (P<0.01). Conclusions Imipinem,cefoperaz one/sulbactam,piperacillin/tazobactam,cefepime,and cefmetazole were the most eff ective agents to clinical isolates of Klebsiella pneumoniae and Escherichia coli in Fuzhou;the production of ESBLs was one of the main resistance mechanisms in Klebsiella pneumoniae and Escherichia coli.It is necessary for clinical laborato ry to detect ESBLs in clinical isolates of Klebsiella pneumoniae and Escherichia coli routinely.