对产超广谱β-内酰胺酶细菌的检测和耐药性分析

目的 :了解临床病人标本中产超广谱 β-内酰胺酶 (ESBLs)细菌的检出率及耐药情况 ,以指导临床合理使用抗生素。方法 :用NCCLS规定的表型确证试验进行ESBLs的检测。结果 :ESBLs的总阳性率为 19.9% ,大肠埃希菌为 18. 1% ,肺炎克雷伯菌为 2 2 . 7%。产ESBLs菌对 8种抗生素的耐药率与不产ESBLs菌相比有显著差异 (P <0 0 5 ) ,对 3种抗生素 (亚胺培南、头孢哌酮 /舒巴坦、哌拉西林 /他唑巴坦 )的耐药率与不产ESBLs菌相比无显著差异。结论 :临床实验室应加强对ESBLs的检测 ,治疗产ESBLs菌引起的感染 ,应选用头霉素、碳青霉烯类及含酶抑制剂的复合抗生素。

Detection of ESBLs-producing strains and analysis of bacterial resistance to antibiotics

Objective:Our objects are to investigate the positive rate of ESBLs-producing (extended-spectrum beta-lactamases) strains and the profile of bacterial resistance in samples isolated from clinical patients, helping rationalize antibiotic use in clinical practice. Methods: The detection of ESBLs-producing strains was performed according to methods published by the NCCLS(national committee for clinical laboratory standards) in 1999 for screening and confirming the presence of ESBLs. Results: The ESBLs-producing strains were and documented in 22.7%(15 of 66) of Kleesiella Pneumoniae strains and 18.1%(19of 105)of the Escherichia coli strains,while in general the ESBLs-producing strains account for 19.9%(34 of 171)of the whole strains isolated. The rates of bacterial resistance to eight antibiotics differed significantly between the ESBLs-producing strains and ESBLs(-) strains,while there did not exist significant difference in the rates of bacterial resistance to three antibodies, including Imipenem, Cefoperazone/Sulbactam, piperacillin-tazobactam, between the two groups mentioned above. Conclusions: The importance of detecting extended spectrum beta-lactamases (ESBLs) occurrence in clinical lab should be reemphasized to give the physician some guidance on the selection of antibodies.For infections due to ESBLs-producing strains, multi-component antibiotic, which usually include cephamycin,cabapenem and enzyme-inhibitor,should be prescribed in priority.