非产超广谱β-内酰胺酶肺炎克雷伯菌耐药性分析

目的了解非产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药情况,为临床合理有效使用抗菌药物提供科学依据。方法回顾性地分析医院2006-2009年住院患者临床送检标本经分离确证的126株非产ESBLs肺炎克雷伯菌,用K-B法测定非产ESBLs肺炎克雷伯菌对12种抗菌药物的耐药率。结果确证的非产ESBLs肺炎克雷伯菌126株对氨苄西林、头孢唑林、氨苄西林/舒巴坦的耐药率70.00%,对头孢呋辛、氧氟沙星、庆大霉素、环丙沙星、左氧氟沙星的耐药率25.00%,对头孢噻肟、头孢曲松、阿米卡星15.00%,对头孢哌酮/舒巴坦高度敏感,耐药率为2.38%。结论非产ESBLs肺炎克雷伯菌对青霉素类、第一、二代头孢菌素耐药严重,对喹诺酮类、氨基糖苷也存在不同程度的耐药,第三代头孢菌素和阿米卡星是临床治疗非产ESBLs肺炎克雷伯菌感染的有效药物。     

肺炎克雷伯菌临床分离株耐药谱变迁分析

目的调查肺炎克雷伯菌临床分离株近年来耐药谱的变迁. 方法菌株鉴定和药敏试验采用VITEK-32全自动微生物分析仪进行测定,超广谱β-内酰胺酶(ESBLs)采用双纸片增效法,对近5年来我院肺炎克雷伯菌的耐药谱进行回顾性调查. 结果肺炎克雷伯菌对青霉素类药物耐药率最高,氨苄西林高达100%;对亚胺培南/西司他丁的耐药率最低,除1998年有1株耐药外其余均为零;耐药率上升最快的是培氟沙星;氨基糖苷类和第三代头孢菌素药物具有较好的体外抗菌活性,产ESBLs株稳定约在20%. 结论肺炎克雷伯菌临床分离株的耐药性日趋严重,氨基糖苷类、第三代头孢菌素及碳青酶烯类抗生素可用于控制肺炎克雷伯菌引起的感染.     

产ESBLs肺炎克雷伯菌耐药性分析

目的了解我院近几年肺炎克雷伯菌的分布及耐药情况,为临床合理使用抗菌药物提供可靠依据。方法按照全国临床检验操作规程第二版培养分离细菌。药敏试验采用纸片扩散（K-B）法。结果分离出的阳性病原菌465株。其中肺炎克雷伯菌120株占阳性标本的25.8%。120株肺炎克雷伯菌中产酶株为22例,产酶率为18.3%。产ESBLs的肺炎克雷伯菌对头孢他啶、头孢呋辛钠、头孢呋辛酯、头孢唑啉、哌拉西林、氨曲南、对氨苄西林和氨苄西林/舒巴坦100%耐药。结论亚胺培南对产ESBLs肺炎克雷伯菌具有很高的敏感性,建议治疗肺炎克雷伯菌感染首选亚胺培南。     

大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶的检测及耐药性分析

[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。     

婴幼儿肺炎克雷伯菌肺炎76例药敏分析

目的 探讨婴幼儿肺炎克雷伯菌的药敏情况,了解肺炎克雷伯菌非产超广谱β内酰胺酶与产超广谱β内酰胺酶的发生情况,以指导临床合理使用抗生素.方法 回顾分析笔者所在医院2007年1月～2009年11月住院患儿的临床资料,呼吸道分泌物细菌培养出肺炎克雷伯菌,进行鉴定及药敏试验测定,并行SEBLs检测.结果 培养出76株肺炎克雷伯菌,其中非产ESBLs菌株43例,占56.58%,对美洛培南、左氧氟沙星100%敏感,对哌拉西林/他唑巴坦、第三代头孢菌素抗生素有较低的耐药率;产SEBLs菌株33例,占43.42%,对美洛培南、左氧氟沙星100%敏感,第三代头孢菌素绝大部分耐药.结论 肺炎克雷伯菌非产SEBLs菌株普遍敏感,产SEBLs菌株耐药强.应根据药敏试验结果选择敏感抗生素,以减少ESBLs菌株的产生.     

2009年肺炎克雷伯菌的分布及耐药性分析

目的调查医院2009年肺炎克雷伯菌的分布和耐药情况,以给临床合理用药提供参考。方法收集临床分离的肺炎克雷伯菌培养鉴定,采用纸片扩散法(K-B法)或微量稀释法(MIC)测定24种抗菌药物的敏感情况,用WHONET 5软件进行分析。结果 266株肺炎克雷伯菌产ESBLs发生率为30.45%;对氨苄西林的耐药率高达99.62%;对哌拉西林的耐药率为40.60%;喹诺酮类药物耐药率为17.29%;头孢唑林、氨苄西林/舒巴坦、头孢呋辛、头孢他啶、氨曲南、头孢曲松、头孢噻肟、头孢吡肟、磺胺甲噁唑/甲氧苄啶、呋喃妥因、庆大霉素的耐药率在36.09%～17.29%依次递减。结论肺炎克雷伯菌对所有抗菌药物具有一定程度的耐药性,应根据药敏结果合理选用抗菌药物。     

肺炎克雷伯菌医院感染及耐药性监测

目的:调查医院肺炎克雷伯菌的耐药现状,为临床合理用药提供依据。方法:用K-B法做体外药敏试验,用纸片确证法检测产超广谱β-内酰胺酶(ESBLs)细菌。结果:医院肺炎克雷伯菌产ESBLs率为27.3%;132株肺炎克雷伯菌对亚胺培南100%敏感,对头孢类抗生素,如头孢他啶、头孢曲松、头孢吡肟、头孢唑啉的耐药率分别为44.1%、48.7%、39.6%和66.9%。结论:医院应重视肺炎克雷伯菌的耐药监测,以预防医院感染的发生与爆发流行。     

1051株临床肺炎克雷伯菌的药敏分析

目的了解临床肺炎克雷伯菌的分离及对抗菌药物的耐药率变化。方法对2007-2010年医院临床分离的肺炎克雷伯菌进行统计,并分析其耐药性。结果 2007-2010年临床分离的肺炎克雷伯菌株数逐年增加,分别为129、239、326、357株,检出率分别为21.86%、17.52%、15.95%、15.28%;肺炎克雷伯菌对氨苄西林、头孢西丁、头孢唑林、庆大霉素、亚胺培南等抗菌药物的耐药率差异有统计学意义(P<0.05)。结论肺炎克雷伯菌临床分离株数较多,耐药率较高,应加强临床合理使用抗菌药物的管理,预防和减少多药耐药菌的产生。     

大肠埃希菌和肺炎克雷伯菌的耐药性分析

[目的]分析从住院患者中分离出的大肠埃希菌和肺炎克雷伯菌的耐药性变化,为临床合理使用抗生素提供依据.[方法]用常规方法分离鉴定病原菌,用K-B法做药物敏感试验.[结果]从2004-2006年,大肠埃希菌和肺炎克雷伯菌共检出781株.其中产超广谱β-内酰胺酶(ESBLs)菌占67.2%.3年中ESBLs总的检出率依次为51.6%,60.8%,78%,ESBLs的检出率呈逐年上升趋势.产超广谱β-内酰胺酶(ESBLs)的细菌对抗菌药物的耐药率明显高于不产ESBLs的细菌. [结论]本地区大肠埃希菌和肺炎克雷伯菌中产ESBLs的菌株检出率逐年上升,临床应严格合理使用抗菌药物.防止产ESBLs的大肠埃希菌和肺炎克雷伯菌在医院内暴发流行.     

早产儿肺炎克雷伯菌感染临床分析

目的 了解广东省第二人民医院新生儿重症监护室(NICU)早产儿肺炎克雷伯菌感染的发生率、危险因素、分布情况及耐药情况.方法 回顾性分析广东省第二人民医院2010年3月至2015年3月期间收治的早产儿1716例,对52例发生肺炎克雷伯菌感染患儿的一般资料、相关因素、药敏分析等情况进行统计分析.结果 1716例早产儿中52例发生肺炎克雷伯菌感染,其感染率为3.15%,感染中位数为15.9天,平均数为19.3±12.7天;其中血行感染36例,肺部感染16例;药敏分析显示其对三代头孢耐药率为88.5%~100%,对四代头孢耐药率为88.5%,未发现对哌拉西林他唑巴坦、头胞哌酮舒巴坦及碳青霉烯类抗生素耐药菌.其中超广谱β-内酰胺酶(ESBL)(+)21例,耐药率远高于ESBL(-)菌株.结论 肺炎克雷伯菌是NICU医院感染的重要病原菌,以血行感染为主,且耐药发生率高,迫切需要加强院感防控措施,合理使用抗生素,减少侵入性操作及加强手卫生,减少医院感染的发生.     

Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use.

OBJECTIVE: To identify antibiotic resistance trends and risk factors for resistance of Serratia species to third-generation cephalosporins. DESIGN: Retrospective survey of medical records. SETTING: A 2,200-bed, tertiary-care hospital. PATIENTS: One hundred twenty-two patients with Serratia bacteremia between January 1991 and June 2001. METHODS: Infectious disease physicians collected data from medical records regarding patient demographics, underlying disease or condition, portal of entry, microorganism, antibiogram, complications, antibiotics received, and outcome. RESULTS: Among 122 Serratia isolates, 117 (95.9%) were Serratia marcescens and 110 (90.2%) were of nosocomial origin. During the study period, the 122 isolates showed a high rate of resistance to third-generation cephalosporins (45.9%) and extended-spectrum penicillins (56.6%). The resistance rate to ciprofloxacin was 32.0%. The resistance rate to third-generation cephalosporins increased from 31.7% for 1991 to 1995 to 54.9% for 1996 to 1998 and 50.0% for 1999 to 2001. In the multivariate analysis, prior use of a second-generation cephalosporin (adjusted odds ratio [OR], 5.90; 95% confidence interval [CI90], 1.41 to 24.6; P = .015) or a third-generation cephalosporin (OR, 3.26; CI95, 1.20 to 8.87; P = .020) was a strong independent risk factor for resistance to third-generation cephalosporins. The overall case-fatality rate was 25.4% (Serratia bacteremia-related case-fatality rate, 13.1%). CONCLUSION: Prior use of a second- or third-generation cephalosporin was the most important risk factor for bacteremia with Serratia resistant to third-generation cephalosporins, suggesting the need for antibiotic control. The potential role of patient-to-patient spread could not be fully evaluated in this retrospective study.     

Monitoring antibiotic resistance in Argentina. The WHONET program, 1995-1996]

The World Health Organization has implemented a surveillance program for antimicrobial resistance that is known as WHONET. In Argentina the program was developed through a network of 23 public and private hospitals that participate in national and international quality-control programs. Between January 1995 and December 1996, the antimicrobial susceptibility of 16,073 consecutive clinical isolates was determined, using the recommended standards of the National Committee for Clinical Laboratory Standards of the United States of America. More than half of the Escherichia coli urinary isolates were resistant to ampicillin and more than 30% to trimethoprim/sulfamethoxazole (SXT). When the percentage of resistant isolates from outpatients (OPs) was compared to that observed in hospitalized patients (HPs), a marked difference in antimicrobial activity was noted in the case of gentamicin (2% from OPs resistant vs. 8% from HPs resistant), norfloxacin (2% vs. 6%), and third-generation cephalosporins (7% vs. 15%). Of the Klebsiella pneumoniae isolates recovered from blood cultures, 71% and 60% showed resistance to third-generation cephalosporins and to gentamicin, respectively. The overall rate of oxacillin resistance in Staphylococcus aureus was 39%. Around half of the Enterococcus spp. isolates showed high resistance to aminoglycosides, but resistance to glycopeptides was not found. In Argentina, ampicillin and SXT were not suitable for treating diarrhea. Shigella flexneri had a higher number of isolates resistant to both of those drugs (87% and 74%, respectively) than Sh. sonnei did (47% and 71%, respectively). About 40% of the Salmonella spp. isolated in pediatric hospitals were resistant to third-generation cephalosporins. When microorganisms causing bacterial meningitis were examined, Streptococcus pneumoniae showed a resistance rate of 18% to penicillin and Haemophilus influenzae a resistance rate of 19% to ampicillin. These rates are within the intermediate range reported for other countries of the Americas and for Europe.     

新生儿院内超广谱β-内酰胺酶菌株所致肺炎临床相关因素分析

目的探讨新生儿病房超广谱β-内酰胺酶菌株所致院内肺炎的临床特点及相关因素。方法总结我 院新生儿科产超广谱β-内酰胺酶(ESBLs)细菌所致院内肺炎患儿的临床表现、病原学情况、影响因素及治疗转归。 结果在81例院内肺炎的新生儿呼吸道分泌物中培养出产ESBLs细菌34株,来源于31例新生儿院内肺炎的患 儿,主要以肺炎克雷伯菌、大肠埃希菌为主;同期同类菌属中非产ESBLs菌株所致的新生儿院内肺炎50例,致病菌 株50株。产ESBLs菌株对三代头孢菌素、氨曲南、氨苄西林耐药率高,对亚胺培南普遍敏感,对阿米卡星、头孢吡 肟部分敏感。使用三代头孢菌素治疗组与其它抗菌药物治疗组产ESBLs菌株分离率分别为65.12％,7.89％,两组 比较,差异有显著性(P<0.01);早产儿组产ESBLs细菌菌株分离率(63.64％)明显高于足月儿组(20.83％),两 组比较,差异有显著性(P<0.01);在本组研究的患儿疾病种类中,以新生儿感染性肺炎、新生儿肺透明膜病患儿 院内感染产ESBLs细菌的分离率较高,分别为70.00％,58.33％;非产ESBLs细菌感染组平均机械通气时间为5.6 ±1.7 d,明显低于产ESBLs细菌感染组(9.8±2.9 d),两组比较,差异有显著性(P<0.01)。结论广泛或长时 间使用第三头孢菌素、早产、长时间机械通气为产ESBLs细菌感染的危险因素;对于产ESBLs     

肺炎克雷伯菌医院感染的临床特点与耐药性分析

目的了解肺炎克雷伯菌医院感染的临床特点与耐药特征。方法分析2008年1月～2010年12月195例肺炎克雷伯菌医院感染患者的临床资料,采用K-B纸片扩散法进行药敏试验及ESBLs的表型筛选和确证试验。结果医院感染肺炎克雷伯菌标本主要来源依次为痰液、血液、胆汁和尿液;检出科室以重症监护室、肝胆外科、神经外科和血液内科为主;大部分患者存在严重基础疾病和导致感染的危险因素;肺炎克雷伯菌对亚胺培南最敏感;产ESBLs菌株检出率为50.3%;产ESBLs菌株耐药率明显高于非产ESBLs株。结论 ESBLs在肺炎克雷伯菌医院感染中十分流行,多重耐药明显,做好细菌耐药性监测,合理使用抗生素十分重要。     

Sequential emergence of multi-resistant Klebsiella pneumoniae in Bahrain

During the mid-1980s, nosocomial infections due to aminoglycoside-resistant Klebsiella pneumonia were prevalent in the intensive care unit (ICU) of the Salamanya Medical Centre, Bahrain. In an attempt to control the spread of such organisms, the third-generation cephalosporins were introduced in early 1987. Subsequently there was a marked increase in the incidence of cephalosporin resistance among Klebsiella spp. isolated in the ICU. In 1990, over 60% of Klebsiella isolates were resistant to both cephalosporins and aminoglycosides. Cephalosporin resistance was due to production of extended-spectrum β-lactamases encoded on the same plasmid as aminoglycoside resistance. The incidence of cephalosporin resistance declined during 1991–1992, which was coincident with severe restrictions on the use of third-generation cephalosporins and the preferential use of ciprofloxacin and imipenem for nosocomial klebsiella infections. Sequential overuse of aminoglycosides and cephalosporins for nosocomial klebsiella infection may select for organisms resistant to both classes of antibiotics.     

Nosocomial infection with cephalosporin-resistant Klebsiella pneumoniae is not associated with increased mortality.

OBJECTIVE: To evaluate whether resistance to third-generation cephalosporins and/or aztreonam was associated with a higher mortality rate among patients with nosocomial Klebsiella pneumoniae infections. DESIGN: Retrospective cohort study.Setting. Tertiary care university hospital. METHODS: A total of 143 patients with nosocomial infections due to K. pneumoniae were evaluated. Death within 21 days after diagnosis of infection was the outcome. Demographic data, invasive procedures, presence and severity of underlying conditions, infection diagnosis, anatomic site of isolation, and treatment of infection, as well as resistance to third-generation cephalosporins and/or aztreonam, were evaluated for association with the outcome. RESULTS: The mortality associated with nosocomial K. pneumoniae infections was 22% in our study. Drug resistance was found in isolates from 48% of case patients. Multivariate analysis demonstrated that the severity of the patient's underlying condition (odds ratio, 12.50; P<.01) and isolation of the microorganism from the blood or from another usually sterile site (odds ratio, 2.94; P=.03) were associated with death. On the other hand, the presence of resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. When only the severe cases of infection were analyzed, the results were unchanged. CONCLUSIONS: Resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. The reasons for this are not clear. It is possible that the severity of the underlying disease and the patient's condition have a larger role than the K. pneumoniae infection in determining the outcome, and initially inadequate treatment may not have an impact sufficient to cause irreversible damage, allowing treatment to be changed to an effective drug.     

ICU产超广谱β-内酰胺酶细菌医院感染危险因素及耐药性分析

目的探讨ICU产超广谱β-内酰胺酶(ESBLs)细菌医院获得性感染的危险因素及其耐药性,为其防治提供依据。方法采用病例对照研究,收集医院ICU 2006年8月~2009年6月ESBLs细菌引起的医院获得性感染病例63例,并随机选择同时期126例ESBLs阴性菌医院感染作为对照组,采用单因素分析及多因素Logistic回归分析其危险因素,并使用K-B纸片琼脂扩散法测定其对15种抗菌药物的耐药性。结果单因素分析发现,入住ICU时间≥15 d、侵入性操作、长期使用三代头孢、氟喹诺酮类抗菌药物、抗酸剂及使用激素与ESBLs菌医院感染有关;多因素Logistic回归分析发现,ICU住院≥15 d(OR=1.981,95%CI1.009~3.891)、侵入性操作(OR=4.474,95%CI1.863~10.742)、使用三代头孢(OR=2.443,95%CI1.187~5.028)和氟喹诺酮类抗菌药物(OR=2.448,95%CI1.056~5.677)是独立危险因素;ESBLs菌对亚胺培南、美罗培南、头孢哌酮/他唑巴坦及哌拉西林/他唑巴坦的耐药率均25.0%,其余12种抗菌药物的耐药率均38.0%。结论产ESBLs菌耐药率高,应根据危险因素采取有效措施减少ICU患者ESBLs菌的感染。     

耐氨基苷类高水平肠球菌医院感染的危险因素及氨基糖苷类耐药相关基因研究

目的 了解耐氨基糖苷类高水平肠球菌(HLAR)的耐药性和医院感染的危险因素,研究HLAR氨基糖苷类耐药相关基因类型分布.方法 采用全自动微生物鉴定仪VITEK-AMS对857株肠球菌属进行鉴定及抗菌药物敏感性检测;PCR法检测HLAR氨基糖苷类耐药相关基因,并对PCR结果进行测序分析.结果 肠球菌属中HLAR占50.4％,利奈唑胺、万古霉素和替考拉宁对HLAR的抗菌作用最好,但有3株屎肠球菌对万古霉素和替考拉宁耐药,粪肠球菌对氯霉素和四环素的耐药率高于屎肠球菌,而屎肠球菌对其他常用抗菌药物的耐药率明显高于粪肠球菌,粪肠球菌和屎肠球菌的耐药谱明显不同,aac(6')-Ie-aph(2〃)-Ia基因为耐庆大霉素高水平肠球菌(HLGR)的主要耐药基因,占HLGR的88.0％,严重的基础疾病、侵入性操作和头孢三代抗菌药物和激素的应用是肠球菌属医院感染的常见危险因素.结论 HLAR已成为医院感染的重要耐药菌,HLGR产生的主要机制是aac(6')-Ie-aph(2〃)-Ia基因介导对庆大霉素高水平耐药,控制常见医院感染危险因素,合理使用抗菌药物,可减少HLAR医院感染的发生.     

产超广谱β-内酰胺酶菌的耐药性与基因型分析

目的 分析医院急诊科3年内产超广谱β内酰胺酶(ESBLs)大肠埃希菌与肺炎克雷伯菌的耐药性及基因型,以指导临床用药.方法 采用ESBLs表型确证试验筛选产ESBLs大肠埃希菌与肺炎克雷伯菌,提取产ESBLs菌的质粒DNA,应用聚合酶链反应(PCR)扩增产ESBLs株质粒TEM、SHV、CTX-M1、CTX-M9和OXA5种基因,并对其扩增物进行DNA序列分析,测定大肠埃希菌与肺炎克雷伯菌对17种抗菌药物的耐药性.结果 共检出143株大肠埃希菌与77株肺炎克雷伯菌,其中84株为产ESBLs菌,占38.2％;ESBLs研究菌株全部携带TEM型、77.4％携带CTX-M9型基因;同一菌株携带2、3、4个基因的菌株比例分别为44.8％、33.3％和7.1％;产ESBLs大肠埃希菌与肺炎克雷伯菌为多药耐药菌,其中对青霉素类、第一、二、三代头孢菌素类、磺胺类和氟喹诺酮类耐药率高达80.0％～100.0％;碳青霉烯类对产ESBLs细菌仍保持较高的抗菌效果.结论 产ESBLs大肠埃希菌与肺炎克雷伯菌耐药基因,以TEM型和CTX-M9型为主,携带＞2个耐药基因的产ESBLs菌株比例较高;产ESBLs大肠埃希菌与肺炎克雷伯菌对含酶抑制剂的抗菌药物、碳青霉烯类抗菌药物仍保持较高的敏感性,研究中发现美罗培南耐药菌株,应引起临床重视.     

Nursing home residents and Enterobacteriaceae resistant to third-generation cephalosporins

Limited data identify the risk factors for infection with Enterobacteriaceae resistant to third-generation cephalosporins among residents of long-term-care facilities. Using a nested case-control study design, nursing home residents with clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins were compared to residents with isolates of Enterobacteriaceae susceptible to third-generation cephalosporins. Data were collected on antimicrobial drug exposure 10 weeks before detection of the isolates, facility-level demographics, hygiene facilities, and staffing levels. Logistic regression models were built to adjust for confounding variables. Twenty-seven case-residents were identified and compared to 85 controls. Exposure to any cephalosporin (adjusted odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2 to 13.6) and log percentage of residents using gastrostomy tubes within the nursing home (adjusted OR 3.9, 95% CI 1.3 to 12.0) were associated with having a clinical isolate resistant to third-generation cephalosporins.