大肠埃希菌产超广谱β‐内酰胺酶的监测及危险因素分析

目的调查医院大肠埃希菌感染的临床分布、耐药性及患者感染产超广谱β‐内酰胺酶(ESBLs)菌的危险因素,为临床合理使用抗菌药物提供科学依据.方法采用法国生物梅里埃公司 ATB细菌鉴定仪对产ES‐BLs菌进行检测,药敏试验用K‐B纸片法,根据2005年美国临床实验室标准化委员会标准判断结果,应用WHO‐NET5软件对临床分离细菌的药敏结果进行数据统计分析.结果确证87株产ESBLs菌,产酶率为31.5%;不同标本种类中产ESBLs菌检出情况分别为尿液35株(40.2%),痰液23株(26.4%),血液7株(8.0%);各病区产ES‐BLs菌的分离率以重症监护病房(ICU)最高(47.1%),其次为烧伤病房(40.0%),泌尿外科病房(34.2%);产 ES‐BLs大肠埃希菌的耐药率明显高于非产ESBLs大肠埃希菌;感染产ESBLs菌危险因素为长期使用三代头孢菌素、入住ICU患者.结论该院大肠埃希菌产ESBLs菌尚未有效控制,仍然处于较高水平;治疗大肠埃希菌感染时,需根据药敏结果及患者病情选用碳青霉烯类、氨基糖苷类、β‐内酰胺类抗生素/β‐内酰胺酶抑制剂等.

Surveillance of ESBLs producing in Escherichia coli and analysis of risk factors

Objective To investigate the clinical distribution,drug resistance and risk factor of Escherichia coli（E.coli） infection so as to provide the scientific basis for reasonable clinical use of antibacterials.Methods To detect ESBLs-producing bacteria by ATB microbiological system.The Kirby-Bauer（K-B） test was adopted for the drug susceptibility test.The results were evaluated based on the National Committee for Clinical Laboratory Standards（NCCLS） of USA in 2005.The data were analyzed by using WHONET-5 software.Results 87 strains of ESBLs-producing bacteria were detected and the isolated rate was 31.5%.Among different samples,35 strains（40.2%） of ESBLs-producing bacteria were isolated from urine samples,23 strains（26.4%） from sputum,and 7 strains（8.0%） from blood.The isolated rate of ESBLs-producing bacteria was highest in ICU（47.1%）,the second was in the burn wards（40.0%） and the urology wards（34.2%）.The resistant rates of ESBLs-producing strains were significantly higher than that non ESBLs-producing E.coli.The risk factors for infection of ESBLs-producing bacteria were the long-period use of the third-generation of cephalosporins and admission to ICU.Conclusion ESBLs-producing E.coli isolated in our hospital have not been effectively controlled and are still in high level.In treating E.coli infection,carbopenems,aminoglycosides,β-lactam/β-lactamase inhibitor should be selected according to the results of drug sensitivity tests and disease condition.