肠杆菌科产ESBLs细菌的临床分布和耐药分析

目的探讨临床常见标本中肠杆菌科感染菌中的产超广谱β-内酰胺酶（ESBLs）的分布和耐药情况。方法对湖南省人民医院2008—2010年中肠杆菌科检出的病原菌应用法国生物梅里埃ATB Expression分析仪鉴定，CLSI推荐的双纸片确认ESBLs菌株和进行药敏检测。结果在肠杆菌科4330株细菌中共检出2445株产ESBLs菌，检出率占病原菌57．3％，以痰、尿液、分泌物、脓液等标本检出率为高，不同标本类型检出差异有统计学意义（P〈0．05）；大肠埃希菌、肺炎克雷伯菌菌属组在不同标本类型中产ESBLs组间比较差异有统计学意义（P均〈0．01），产酸克雷伯菌、奇异变形杆菌菌属组中检出差异无统计学意义（P均〉0．05）。各临床病区产ESBLs菌分析：儿科、肾内科、肝胆科、泌尿外科感染的产ESBLs菌均占感染菌56．1％以上，不同病区间产ESBLs检出差异有统计学意义（P〈0．05）；对4种病原菌中产ESBLs中病区比较：大肠埃希菌属组、肺炎克雷伯菌属组中差异有统计学意义（P均〈0．01）；产酸克雷伯菌、奇异变形杆菌菌属组中检出差异无统计学意义（P均〉0．05）。分析20种抗菌药物对4330株细菌中产ESBLs表明：ESBLs阴性菌株已有相当部分耐药，产ESBLs菌株对绝大部分抗菌药耐药，氨苄西林、哌拉西林、头孢类几近完全无效，对阿米卡星部分耐药，唯一可选的只有亚胺培南对产ESBLs菌敏感。结论产ESBLs菌是肠杆菌科感染菌中主要致病菌，且广泛耐药，在使用抗菌药物治疗前必须加强耐药监测、严格合理选择用药。

Clinical Distribution and Drug Resistance of Extended- spectrum Beta - lactamase Producing Enterobacteriaceae Isolates

Objective To explore the distribution and drug resistance of extended-spectrum Beta-lactamase-producing Enterobacteriaceae isolates in clinical regular specimens.Methods Identification of the strains was performed by the ATB Expression of Biomerieux,which were collected from the People’s Hospital of Hunan Province during the period of 2008~2010.Disk diffusion confirmatory tests were used to detect extended-spectrum Beta-lactamases(ESBLs) and analyze the susceptibility test results according to CLSI criterion.Results A total of 2,445 ESBLs-producing strains were isolated,with the detection rate of 57.3%.The ESBLs-positive rates of sputum,urine,secretions and liquor puris specimens were higher,and there were statistically significant differences in ESBLs-positive rate among the different specimens(P<0.05).The ESBLs-positive rates of Escherichia coli and Klebsiella pnenmoniae in different specimens both had statistically significant differences(both P<0.01).But no statistically significant difference was found in acid-producing Klebsiella bacteria and Proteus mirabilis(both P>0.05).The rates of ESBLs-producing strains in the departments of paediatrics,nephrology,hepatology and urinary surgery were all above 56.1%,there were statistically significant differences among the different departments(P<0.05).The rates of ESBLs-producing Escherichia coli and Klebsiella pnenmoniae in different departments both had statistically significant differences(both P<0.05),but no statistically significant difference was found in acid-producing Klebsiella bacteria and Proteus mirabilis(both P>0.05).Antibacterial activities of 20 antimicrobial agents against 4,330 strains of bacteria showed that a great part of ESBLs negative strains were resistant to multiple antibiotics,and most of ESBLs positive strains were resistant to multiple antibiotics.Ampicillin,piperacillin and cephalosporin were nearly unavailable.Some strains were resistant to amikacin,and only imipenem was sensitive to ESBLs-producing strains.Conclusions ESBLs-positive strain is the main pathogenic bacteria in Enterobacteriaceae and extensively drug-resistant,so we must strengthen the drug resistance surveillance and rational use of medicines before beginning antibiotics treatment.