产超广谱β-内酰胺酶细菌监测的动态性研究

目的对产超广谱β-内酰胺酶细菌(ESBLs)的检出率及耐药性进行动态性研究,为临床应用抗菌药提供指导。方法应用回顾性的调查方法对近4年来临床标本分离的1028株大肠埃希菌和986株肺炎克雷伯菌用标准纸片扩散确证法(K-B法)检测其ESBLs阳性率,采用K-B法进行药敏试验。结果近4年,大肠埃希菌产ESBLs阳性率分别为21.8%,24.5%,31.3%,36.5%;肺炎克雷伯菌产ESBLs阳性率分别为20.6%,22.5%,29.9%,34.6%。产ESBLs菌株对头孢菌素类、氟喹诺酮类等常用抗菌药的耐药率明显高于非产ESBLs菌株,对部分联合制剂抗生素的耐药性无明显差异,对碳青霉烯类抗生素均敏感。结论大肠埃希菌、肺炎克雷伯菌中ESBLs阳性率逐年升高;对产ESBLs菌株的治疗以碳青霉烯类抗生素为首选。

Persistent Monitoring of Extended-spectrum Beta-Lactamases Producing Bacteria

Objective To investigate persistently the productive status of extended-spectrum beta-lactamase (ESBLs) producing Eschrichia coli and Klebsiella pneumoniae so as to guide the use of antibiotics in clinic.Methods Retrospective analysis was carried out with 1,028 strains of Eschrichia coli and 986 strains of Klebsiella pneumoniae which were collected from clinical specimens. ESBLs production was tested by standard disk diffusion method. Drug susceptibility was tested by Kirby-Baucer disk diffusion method. Results ESBLs positive rates of Eschrichia coli were 21.8%, 24.5%, 31.3% and 36.5% respectively in the past four successive years. The counterparts of Klebsiella pneumoniae were 20.6%, 22.5%, 29.9% and 34.6% in the same years. The resistance of ESBLs strains to cephalosporins, fluoroquinolones and other antibiotics were significantly stronger than that of ESBLs negative strains. No strains were found to be resistance against carbapenem. Conclusion ESBLs positive rate has a significant increase in the past four years. Carbapenem could be the first choice to treat the infection caused by ESBLs producing Eschrichia coli and Klebsiella pneumoniae.