摘要
目的了解儿童下呼吸道感染病原菌中产超广谱β-内酰胺酶(ESBLs)病原菌感染情况及耐药特征,指导临床合理治疗。方法采集2006年1月-2007年12月本院呼吸科下呼吸道感染住院患儿鼻咽分泌物2696份,培养分离大肠埃希菌及肺炎克雷伯杆菌,对2种细菌采用双纸片法及纸片扩散法(K-B法)检测ESBLs;采用K-B法行药敏试验,检测2种细菌对18种抗菌药物的耐药性,结果采用耐药、中介、敏感表示,并对药敏试验结果进行χ2检验。结果共检测135株菌株,其中大肠埃希菌73株,产ESBLs54株(74.0%);肺炎克雷伯杆菌62株,产ESBLs33株(53.2%)。1～6个月婴儿2种细菌的检出率较其他年龄组高,分别为50株和41株(Pa<0.05)。大肠埃希菌及肺炎克雷伯杆菌产ESBLs株检出率在2a间及各年龄组间均无统计学差异(Pa>0.05)。2种细菌产ESBLs株对青霉素类、头孢菌素类、喹诺酮类、氨基糖苷类及磺胺类抗生素的不敏感率均高于非产ESBLs株,且对大多数β-内酰胺酶类抗生素普遍耐药。无论产酶与否,2种细菌对阿米卡星、头孢西丁、头孢哌酮/舒巴坦、亚胺培南仍有较高的敏感性。结论产ESBLs大肠埃希菌和肺炎克雷伯杆菌检出率极高,且对多种抗生素耐药。应严格控制抗生素用药指征,重视产ESBLs菌的监测和药敏试验结果,合理选用抗生素。
Objective To understand the status and drug resistant patterns of strains of extended spectrum β - lactamase （ESBLs） in children with lower respiratory, tract infection, and to give clinical suggestions for rational treatment. Methods Escherichia coli and klebsiella pneumoniae were isolated from the 2 969 nasopharyngeal secretions which collected from lower respiratoory tract of children in our hospital from Jan. 2006 to Dee. 2007. Dual - sheets and sheets - diffusing method （ K - B method） were used to determine the ESBLs and antibiotic sus- ceptibility was tested by K- B method which included 18 kinds of antibiotics,the results were marked by resistant,intermedial and sensitive. Chi - square test was used to analyze the data. Results Total 135 strains were detected,73 strains were escherichia coli,of which 54 strains （74.0%） produced ESBLs,62 strains were klebsiella pneumoniae, of which 33 strains （53.2%）produced ESBLs. The 2 baeterias were found more in children with 1 - 6 months old than those in other age groups,the ratio of which were 50 strains and 41 strains,respectively （Pa 〈 0.05 ）. There were no statistical differences of the ratio of 2 ESBLs - producing strains between 2 years, neither among each age groups （ Pa 〉 0.05 ）. The resistant rate of ESBLs - producing strains to penieillins, eephalosporins, quinolones, aminoglycosides and sulfamido was higher than that of non ESBLs - producing strains respectively. And the resistant rates to beta - laetam antibiotics of ESBLs strains were located on a high level. Whether producing ESBLs or not,the 2 baeterias were still sensitive to amikacin,cefoxitin,cefoperazone/sulbaetam and imipenem. Conclusions The prevalences of ESBLs - producing escherichia and klebsiella pneumonia were high. There was a muhi - drug resistance to the varied antibiotics. It is very. important to make sputum culture and use sensitive antibiotics in treatment according to drug sensitivity test to control the occurrence and conveying of the ESBI,s.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第22期1740-1742,共3页
Journal of Applied Clinical Pediatrics
基金
苏州社会发展科技计划项目资助(SSO702)
关键词
超广谱Β-内酰胺酶
下呼吸道感染
耐药性
儿童
extended spectrum β - lactamases
lower respirator）, tract infection
drug resistance
child
