广州地区医院感染大肠埃希菌及肺炎克雷伯菌耐药性监测分析

目的 调查广州地区医院感染大肠埃希菌和肺炎克雷伯菌及其耐药性.方法 收集广州地区9所三甲医院和1所二甲医院2007年1月-2008年12月连续分离的引起医院感染作重复首次分离株,采用K-B法检测2种病原菌对抗菌药物的敏感性,采用WHONET-5.3软件进行统计分析.结果 共收集大肠埃希菌4670株,肺炎克雷伯菌2801株,分别占医院感染菌株的14.2％和8.5％,ESBLs阳性率分别为45.7％和41.1％；大肠埃希菌检出率在尿标本最高占43.1％,其次是呼吸道标本占18.5％、伤口脓液及分泌物占14.6％、血液占10.2％等；肺炎克雷伯菌检出率在呼吸道标本最高占60.0％,其次是尿液占15.2％、伤口脓被及分泌物占8.8％、血液占7.6％等；大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南耐药率最低为0.5％～1.0％,其次为头孢哌酮/舒巴坦为4.8％和6.2％,对氟喹诺酮类在34.8％～70.2％；ESBLs阳性菌株对各检测药物耐药性均高于ESBLs阴性菌株.结论 医院感染大肠埃希菌和肺炎克雷伯菌对碳青霉烯类保持高活性,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等含酶抑制剂复合制剂和阿米卡星耐受性低,须加强对地区细菌耐药性的检测,合理选用抗菌药物,控制细菌耐药性的产生和播散.

Surveillance of Escherichia coliand Klebsiella pneumoniae isolates causing hospital-acquired infections in Guangzhou

OBJECTIVE To investigate the antimicrobial resistance among Escherichia coli and Klebsiella pneumoniae isolates causing hospital-acquired infections in Guangzhou.METHODS From Jan 2007 to Dec 2008,consecutive and non-repetitive bacteria were collected from 10 hospitals in Guangzhou,The susceptibility of antibacterial agents were determined by disk agar diffusion testing(Kirby-Bauer method,K-B).Whonet 5.3 software was used to analyze the data.RESULTS A total of 4670(14.2%) E.coli isolates and 2801(8.5%) K.pneumoniae isolates were collected,the prevalence of extended-spectrum β-lactamases(ESBLs) were 45.7% and 41.1%,respectively.The constituent ratio of E.coli was the highest in urine(43.1%),followed by sputum(18.5%),wound(14.6%) and blood(10.2%).Differently,the highest constituent ratio of K.pneumoniae was sputum(60.0%),followed by urine(15.2%),wound(8.8%) and blood(7.6%).The resistant rates of E.coli and K.pneumoniae to imipenem and meropenem were the lowest,varying from 0.5% to 1.0%,the resistance rates to cefoperazone/sulbactam were 4.8% and 6.2%,cefotaxime,ceftazidime,and cefepime varying from 30.8% to 56.9%,fluoroquinolones varying from 34.8% to 70.2%;the resistance of ESBLs-positive strains to tested antibiotics was higher than that of ESBLs-negative strains.CONCLUSION Carbapenem antibiotics remain high antibacterial activity against E.coli and K.pneumoniae causing hospital-acquired infections which have low tolerance to the enzyme-containing inhibitor like cefoperazone/sulbactam,piperacillin/tazobactam and amikacin,it is necessary to strengthen the detection of drug resistance to reasonably choose antibiotics and control the occurrence and spread of bacterial resistance.