肺炎克雷伯菌产ESBLs的检测及耐药性分析

目的了解临床分离的肺炎克雷伯菌产ESBLs情况及耐药性,为临床合理使用抗生素提供依据。方法用VITEK-32细菌鉴定及药敏分析仪对2009年1月-2010年10月临床送检标本中分离出的124株肺炎克雷伯菌进行鉴定及药敏试验,同时用仪器法和双纸片协同试验检测ESBLs。结果肺炎克雷伯菌在重症监护病房（ICU）、感染科检出率分别为17.74%、7.26%;感染部位以呼吸道为主,占37.90%。124株肺炎克雷伯菌共检出ESBLs阳性42株,阳性率为33.87%。产酶和不产酶菌株对氨苄西林均耐药（100%）,而对亚胺培南敏感性较高,达89.42%。对其它抗生素的耐药率,产酶菌株均不同程度地高于非产酶菌株,尤其对头孢曲松、头孢他啶、头孢吡肟等头孢类抗生素均耐药。结论 ESBLs是肺炎克雷伯菌对β-内酰胺类抗生素耐药机制之一,产酶菌耐药率较非产酶菌耐药率高,应加强ESBLs的检测

Analysis of the Detection and Antibiotic Resistance of ESBLs-producing Klebsiella Pneumoniae

Objective To investigate the antibiotic resistance of ESBLs-producing Klebsiella pneumoniae isolated from the clinic and to provide the basis for the rational use of antibiotic.Methods 124 strains Klebsiella pneumoniae isolated from Jan 2009 to Oct 2010 were analyzed,the antibiotic susceptibility was performed with VITEK-32 analyzer,both instrument’s and double-paper tests was used to detected ESBLs.Results The detectable rates of Klebsiella pneumoniae in Intensive Care Unit and Department of Infectious Diseases were 17.74% and 7.26%,respectively.Infection location was focused on respiratory tract,accounting for 37.90%.42 ESBLs positive strains were detected,accounting for 33.87%.Both enzyme-producing and nonenzyme-producing strains were resistant to Ampicillin（100%）;but they were sensitive to Imipenem,accounting for 89.42%.To other Cephalosporin,such as Ceftriaxone,Ceftazidime and Cefepime,the antibiotic resistance rate of enzyme-producing strains was higher than that of the nonenzyme-producing strains.Conclusion ESBLs was one of the mechanism that Klebsiella pneumoniae was resistant to β-lactam antibiotics,resistance rate of enzyme-producing strain was higher than that of nonenzyme-producing strain,the detection of ESBLs should be strengthened.