重症监护病房(ICU)两种产超广谱B-内酰胺酶细菌耐药性动态分析

目的对医院ICU(重症监护病房)两种常见产超广谱B-内酰胺酶(ESBLs)细菌的检出率及耐药性进行动态观察,为指导临床合理使用抗生素提供依据。方法对我室2006至2009年从ICU标本分离的479株肺炎克雷伯菌和491株大肠埃希菌采用纸片协同试验和双纸片确证试验检测其ESBLs,并用纸片扩散法进行药敏试验。结果四年来大肠埃希菌产ESBLs阳性率从41.6%上升至58.4%;肺炎克雷伯菌产ESBLs阳性率从29.0%上升至35.3%。产ESBLs株对常用抗菌药物的耐药率明显高于非产ESBLs株,但对碳青霉烯类抗菌药物都敏感。结论 4年来,大肠埃希菌、肺炎克雷伯菌中ESBLs阳性率逐年升高,对产ESBLs菌株的治疗应首选含酶抑制剂的抗生素、非B内酰胺类敏感的抗生素或碳青霉烯类抗菌药物。

The dynamical analysis of two Extended-spectrum beta-lactamases (ESBL)-producing bacterias in intensive care unit(ICU)

Objective analyse the detection rate and drug resistance of two common Extended-spectrum beta-lactamases（ESBL）-producing bacterias in intensive care unit（ICU） dynamically to provide an evidence for clinical doctors to choose antibiotics reasonably.Methods Between year 2006 and 2009,test Extended-spectrum beta-lactamases（ESBL）-producing rate of 479 Klebsiella pneumoniae and 491 Escherichia coli isolated from the samples of patients in ICU by disk synergy test and double disk test confirmatory test,at the same time do the antibiotics sensetivity test with disk diffusion method.Results In recent four years the positive rate of extended-spectrum beta-lactamases（ESBL）-producing Escherichia coil have increased to 58.4% from 41.6%,which of Klebsiella pneumoniae have increased to 35.3% to 29.0%.The drug resistance rate of extended-spectrum beta-lactamases（ESBL）-producing bacterias is higher obviously than that of the bacterias which don＇t produce extended-spectrum beta-lactamases（ESBL）.However,all these bacterias are sensetive to Carbapenem antibiotics.Conclusion The positive rates of Extended-spectrum beta-lactamases（ESBL）-producing Escherichia coli and Klebsiella pneumoniae have increased year by year in recent 4 years.For the therapy of extended-spectrum beta-lactamases（ESBL）-producing bacterias,the antibiotics including beta-lactamases inhibitor,antibiotics unsensetive to beta-lactamases and Carbapenem antibiotics should be choosed firstly.