医院获得性肺炎克雷伯菌和大肠埃希菌下呼吸道感染及耐药分析

目的　了解我院呼吸监护病房 (RICU )和普通病房肺炎克雷伯菌和大肠埃希菌医院获得性下呼吸道感染以及超广谱β-内酰胺酶 (ESBL s)的发生率、流行情况、耐药性 ,并探讨 ESBL s产生的危险因素。方法　收集肺炎克雷伯菌和大肠埃希菌医院获得性下呼吸道感染共 114例 ,ESBL s的检测用纸片扩散表型试验确证。结果　大肠埃希菌中产 ESBL s菌株为 4 0 .0 % ,肺炎克雷伯菌中产 ESBL s菌株为 2 1.6 % ,总检出率为 2 8.1% ,RICU的肺炎克雷伯菌和大肠埃希菌产 ESBL s率为 5 8.6 % ,明显高于呼吸普通病房 17.6 % (P<0 .0 0 1) ;上述产 ESBL s菌株对亚胺培南高度敏感 (10 0 % ) ,对哌拉西林 /他唑巴坦为 6 2 .5 % ,对头孢哌酮 /舒巴坦为 5 9.3%。结论　除亚胺培南外 ,哌拉西林 /他唑巴坦和头孢哌酮 /舒巴坦也可作为治疗产 ESBL s细菌感染的药物 ,改善营养状况、减少侵入性操作、减少激素或制酸剂的应用可能减少 ESBL s菌株的出现 ,降低患者病死率。

Hospital Acquired Infection of Low Respiratory Tract by Klebsiella pneumoniae and Escherichia coli and Their Antibiotic Resistance

OBJECTIVE To investigate the prevalence and resistance of ESBLs producing strains in Klebsiella pneumoniae and Escherichia coli isolated from patients with hospital acquired infection of low respiratory tract by them and to explore the risk factors of the occurrence of ESBLs strains.METHODS A total of 114 cases with hospital acquired infection of low respiratory tract by K. pneumoniae and E. coli were collected. Bacterial susceptibility testing was done by Microscan WalkAway 40, results were assessed according to NCCLS2000.RESULTS The incidence of ESBLs producing strains was 40.0% in E. coli and 21.6% in K. pneumoniae with the overall incidence of 28.1%. The incidence of ESBLs producing strains was 58.6% in E. coli and K. pneumoniae in RICU, it was significantly higher than that in respiratory ward (17.6%,P< 0.001). ESBLs producing strains were sensitive to imipenem (100%), the sensibility to piperacillin/tazobactam and cefoperazone/sulbactam was 62.5% and 59.3% , respectively.CONCLUSIONS Piperacillin/tazobactam and cefoperazone/sulbactam are also relatively susceptible drugs in clinical therapy. Reducing the use of hormones and antacid and invasive operation, improving nutritional status may decrease the infection of ESBLs strain.