烧伤病区产超广谱β-内酰胺酶革兰阴性菌分离率及耐药性分析

目的了解我院特别是烧伤病区产超广谱β-内酰胺酶(ESBLs)大肠杆菌、肺炎克雷伯杆菌的流行情况,检测其对常用抗生素的耐药性,为临床治疗和控制ESBLs菌感染及流行提供重要依据.方法通过中心化验室收集我院2000年3月～2001年2月住院患者送检标本中大肠杆菌、肺炎克雷伯杆菌共计258株,应用VITEK自动检测系统(GNS-506药敏分析卡)及双纸片扩散法筛选产ESBLs菌.根据VITEK自动检测系统药敏检测结果分析比较产ESBLs菌和非产ESBLs菌对15种抗生素的敏感性,并对其中38株产ESBLs阳性菌进行12种临床常用抗生素MIC检测.结果 258株入选菌株中产ESBLs阳性率分别为:大肠杆菌18.8%(29/154);肺炎克雷伯杆菌12.5%(13/104).按标本种类分析,分泌物标本培养产ESBLs阳性率最高,为25.5%,与其他标本培养的总阳性率间的差别有显著性意义;按病区分析,烧伤病区产ESBLs阳性率(大肠杆菌38.5%;肺炎克雷伯杆菌25.0%)与其他病区产ESBLs阳性率间差别有显著性意义.药敏结果:产ESBLs的大肠杆菌和肺炎克雷伯杆菌对亚胺培南、美洛培南及头孢西丁的敏感率较高,其次是氨基糖苷类抗生素,产ESBLs的肺炎克雷伯杆菌对哌拉西林/三唑巴坦敏感,对其他抗生素的敏感性下降.结论烧伤病区是产ESBLs菌的高发病区,产ESBLs菌对亚胺培南的敏感率最高,其次是美洛培南、头孢西丁和丁胺卡那.

A survey of the prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Burn Unit

Objective To determine epidemic features of extended-spectrum beta-lactamase(ESBL)-producing Escherichia coli(E coli) or Klebsiella pneumoniae(K pneumoniae) in burn unit.Methods 258 non-duplicated strains of E coli and K pneumoniae were collected from different wards in hospital during Mar.2000 to Feb.2001.Producing ESBLs strains were detected by using GNS-506 susceptibility card of Vitek-60 system and double-disk synergy test. The antimicrobial susceptibility of all the strains was detected by Vitek system.Results 42 strains producing ESBLs were found in 258 strains.Of these,18 8% of E coli,12 5% of K pneumoniae were the ESBLs producing strain.The isolated rate of ESBLs in burn unit(E coli 38 5%;K pneumoniae 25 0%) was higher than that in other wards.The antimicrobial susceptibility of isolated strains producing ESBLs was lower than that of non-producing ESBLs strains.Imipenem,meropenem and cefoxitin were the most active antibiotics against ESBLs-producing E coli and K pneumoniae,while amikacin and netilmicin also showed higher activity.Conclusion Burn unit is one of the highest epidemic wards of ESBLs-producing E coli or K pneumoniae.Imipenem,meropenem,cefoxitin could be a better choice to control the burn infection due to ESBLs-producing organisms.