产超广谱β—内酰胺酶肺炎克雷伯氏菌和大肠埃希氏菌呼吸道感染的临床分析

为探索产超广谱β-内酰胺酶（ESBLs)的肺炎克雷伯氏菌和大肠埃希氏菌呼吸道感染的临床特点，寻找有效的预防和治疗措施，对92株肺炎克雷伯氏菌和大肠埃希氏菌采用双纸片法检测出产ESBLs的肺炎克雷伯氏菌28株和大肠埃希氏菌株16株，并以是否产ESBLs分为四组，对四组的抗生素耐药性，预后和本次发病前3个月抗生素使用情况作了初步研究，结果，肺炎克雷伯氏菌产ESBLs率为47．5％，大肠埃希氏菌产ESBLs率为48．5％，产ESBLs的肺炎克雷伯氏菌和大肠埃希氏菌对青霉素类，第一，二，三，代头孢菌素和部分氨基糖苷类有极高的耐药性，与不产ESBLs组相比耐药性高（P＜0．05），但对阿米卡星和亚胺培南相当敏感，对复方新诺明和头孢西丁尚有一定的敏感性，产ESBLs的肺炎克雷伯氏菌和大肠埃希氏菌两组患者本次发病前青霉素类，头孢菌素类，喹诺酮类等抗生素的使用多于不产ESBLs组（P＜0．05），产ESBLs的肺炎克雷伯氏菌和在肠埃希氏菌所致的呼吸道感染得死亡率高于不产组（P＜0．05），结果提示，产ESBLs的肺炎克雷伯氏菌和大肠埃希氏菌所致的呼吸感染患者死亡率高于不产组（P＜0．05），结果提示，产ESBLs的肺炎克雷伯氏菌和大肠埃希氏菌的出现可能与各类抗生素的广泛使用有关，ESBLs菌引起的感染预后差，治疗ESBLs菌引起的感染可用亚胺培南，阿米卡星，复方新诺明，头孢西丁以及药敏试验显示敏感的药物。βββββ

Clinical analysis of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum beta-lactamases in patients with respiratory tract infection

Objective: To investigate the antibiotic resistance of strains producing ESBLs among Klebsiella pneumoniae and Escherichia coli in patients with respiratory tract infection, and the prognosis of these patients . Methods: 92 strains of Klebsiella pneumoniae and Escherichia coli in 78 patients with respiratory tract infection were analysed; 16 strains of ESBLs producing E.coli and 28 strains of ESBLs producing K.pneumoniae were determined by Vitet method and antibiotic susceptibility test. The prognosis and relationship between antibiotics used and ESBLs producing ones were evaluated. Results: The prevalence of ESBLs in isolates of 59 K.pneumoniae was 47.5% and E.coli 48.5% respectively. The resistant rate of ESBLs producing strains to aminoglycosides (except amikacin), quinolones, cephalosporins and ampicillin was higher than that of non ESBLs producing strains. ESBLs producing strains had higher resistant rate to aminoglycosides (except amikacin), quinolones, second and third generation cephalosporins and ampicillin, but few of which was resistant to imipenem and amikacin. The susceptibility rate of these strains to sulfonamides and cefoxitin was about 37.5% ~50%. The mortality of patients with respiratory tract infection of ESBLs producing strain was higher. Conclusion: The results indicated that such antibiotics as imipenem, amikacin, sulfonamides, cefoxitin and others which are susceptible to ESBLs producing strain can be used. The prognosis of patients with respiratory tract infection of ESBLs producing strain was poor. The unreasonable using of antibiotics may lead to the spread of ESBLs producing strain.