ICU内超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌的检测及耐药性分析

目的 了解重症监护病房(ICU)超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌和大肠埃希菌的检出率及耐药情况,为临床抗感染治疗提供依据.方法 对我院ICU 2008年1月至2010年12月住院患者分离出的肺炎克雷伯菌和大肠埃希菌,采用NCCLs推荐的纸片扩散表型确证试验进行ESBLs细菌的检测,药敏试验采用琼脂扩散(K.B)法.结果 90株肺炎克雷伯菌和大肠埃希菌中检出产ESBLs菌49株,总检出率为54.4%(49/90);其中肺炎克雷伯菌产ESBLs检出率为52.5%(31/59);大肠埃希菌产ESBLs检出率为58.1%(18/31);以呼吸道标本的检出率最高,占75.5%(37/49).产ESBLs菌对青霉素类和头孢菌素类抗菌药物均高度耐药,对氨基糖苷类、喹诺酮类等呈多重耐药,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁、阿米卡星的耐药率均较低;对亚胺培南全部敏感.产ESBLs菌株对抗菌药物的耐药率明显高于非产ESBLs菌株.结论 ICU内产ESBLs肺炎克雷伯菌和大肠埃希检出率较高,对大多数抗菌药物耐药且呈多重耐药性,亚胺培南是治疗产ESBLs菌感染的首选药物.及时检测ICU内产ESBLs菌及其耐药情况对指导临床用药至关重要.

Abstract：

Objective To analyse the detection rates and antibiotic resistance of extended-spectrum β-lactamases (ESBLs) producing Klebsiella pneumonia and Escherichia coli in Intensive Care Unit (ICU) and to guide the clinical administration of treatment Methods Klebsiella pneumonia and Escherichia coli collected from clinical samples from January 2008 to December 2010 were tested by Phenotypic Confirmatory Test and confirmed by the method advised by NCCLs and drug-sensitivity was tested with K-B. Results Among the isolated 90 samples,49 strains were considered ESBLs-producing bacteria (54.4%) .with 52. 5% (31/59)of Klebsiella pneumonia and 58. 1% (18/31) of Escherichia coli respectively; with the specimens of respiratory system having the highest rate of 75. 5% (37/49). ESBLs producing bacteria were highly resistant to penicillins and cephalosporins, multi drug resistant to aminoglycosides and quinolones; low to piperacillin/tazobactam,cefoperazone/sulbactam,cefoxitin and amikacin; and all sensitive to imipenem. When compared to non-ESBLs producing strains, the rates of antibiotic resistance of the producing ESBLs strains were significantly higher. Conclusion The test results showed that the isolation rates of ESBLs-producing Klebsiella pneumoniae and Escherichia coli in ICU were high,which had high resistance to most antimicrobial agents,and the resistance was multiple. Imipenem could be the best choice to control the infection due to ESBLs-producing organisms. Timely detection of ESBLs producing bacteria and drug resistance is essential to guide clinical antibiotic using in ICU.