近三年产超广谱β-内酰胺酶菌株分布及药敏变迁

目的 研究我院近三年产超广谱β-内酰胺酶(extended spectrum Blactamase，ESBL)大肠埃希氏菌和肺炎克雷伯氏菌分布及药敏变迁。方法 收集2000年1月～2002年10月期间临床分离的大肠埃希氏菌和肺炎克雷伯氏菌。采用NCCLS 1999年推荐的酶抑制剂增强纸片扩散试验对其产ESBLs及耐药情况进行研究。结果 (1)以头孢噻肟为指示剂检测ESBLs。3年共分离出产ESBLs大肠埃希氏菌94株和肺炎克雷伯氏菌64株。分别占18．8％和21．1％，且ESBLs菌株检出率逐年增加。而以头孢他啶为指示剂检测ESBLs，耐头孢他啶的大肠埃希氏菌2l株和肺炎克雷伯氏菌14株；(2)外科病房分离的ESBLs占32．9％(52／158)，儿科占14．6％(23／158)，呼吸科占12．7％(20／158)；(3)呼吸道分泌物分离的ESBLs占27．8％(44／158)，尿标本占22．2％(35／158)。伤口分泌物占20．3％(32／158)，血占12．0％(19／158)，体液或引流液占12．0％(19／158)；(4)抗菌药物对产ESBLs大肠埃希氏菌的敏感性高低顺序依次为：亚胺培南loo．0％，阿米卡星70．3％，头孢他啶66．7％。头孢吡肟44．7％，庆大霉素25．5％，头孢哌酮／舒巴坦25．0％。抗菌药物对产ESBLs肺炎克雷伯氏菌的敏感性高低顺序依次为：亚胺培南l00．0％，阿米卡星76．2％，头孢他啶70．3％，头孢吡肟69．2％，头孢哌酮／舒巴坦58．1％，环丙沙星50．0％。结论 随着抗生素的使用日益增多．临床实验室应将ESBLs作为常规检测项目。以指导临床用药。同时加大对第三代头孢菌素应用的监督，以减轻抗生素的选择压力。

Distribution and trend of antibiotics resistance of extended- spectrum β- lactamases- producing Escherichia coil and Klebsiella pneumoniae in the late three years

Objective To investigate the pathogenic distribution and tre nd of antibiotics resistance of extended-spectrum a-lactamases (ESBLs)-p roducing Escherichia coil and Klebsiella pneumoniae in the late three years in our hospital. Methods E.coli and K.pneumoniae were collected from January, 2000 to October, 2002. ESBLs- producing isolates were detected by inhibitor-potentiated disc diffusion te st and the bacterial susceptibility test against 17 antibacterial agents was per formed by agar dilution test.Results (1) The incidence of ESBLs producing E.coli and K.pneumoniae using cefotaxime as indicators were 18.8% (94/499) a nd 21.1% (64/303) respectively. Resistant to ceftazidime were 21 and 14 isolates, respectively.(2) ESBLs in s urgical department, pediatrics and respiratory department were 32.9% (52/158), 14.6% (23/158),12.7% (20/158),respectively.(3) ESBLs in sputum,urine,wounds,b lood and body fluids were 27.8% (44/158),22.2% (35/158),20.3% (32/158),12. 0% (19/158) and 12.0% (19/158),respectively.(4) The sensitive rates of ESBLs-producing E.coli isolates to imipenem,amikacin,ceftazidime,cefepime,gentamici n and cefoperazone/ sulbactam were 100.0% ,70.3% ,66.7% ,44.7% ,25.5% and 25.0% ,respectively.The sensitive rates of ESBLs-producing K.pneumoniae isola tes to imipenem,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam and ciprofl oxacin were 100.0% ,76.2% ,70.3% ,69.2% ,58.1% and 50.0% ,respectively.Co nclusions The resistance rates of ESBLs-producing E.coli and K.Pneumoniae isol ates to most antimicrobial agents were high.Antibiotics should be used rationall y in the treatment of infections caused by ESBLs-producing strains.