摘要
目的分析泌尿系感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌的耐药性,为临床合理选用抗菌药物提供依据。方法收集2009年1月-2010年7月中段尿标本共1019份,采用法国生物梅里埃VITEK-2Compact全自动微生物分析仪进行细菌学鉴定和药敏试验,采用NCCLS推荐的双纸片和表型确证试验检测产ESBLs细菌。结果 1019份标本中共分离革兰阴性杆菌254株,阳性率为24.9%,其中大肠埃希菌127株占50.0%,肺炎克雷伯菌74株占29.1%;产ESBLs大肠埃希菌50株,检出率为39.4%,产ESBLs肺炎克雷伯菌33株,检出率为44.6%;两组产与非产ESBLs菌株对头孢替坦、亚胺培南、美罗培南及哌拉西林/他唑巴坦表现为低耐药性,耐药率<24.2%,产ESBLs菌株对其他β-内酰胺类、氨基糖苷类、喹诺酮类及磺胺类等药物体表面现出多药耐药,非产ESBLs大肠埃希菌表现为中介或耐药,非产ESBLs肺炎克雷伯菌对氨苄西林和哌拉西林表现为高耐药,耐药率>97.6%,除头孢呋辛酯外,对其他药物体表面现为低耐药性。结论泌尿系统感染产ESBLs菌株的耐药性较非产ESBLs菌株高,且呈多药耐药性,是临床抗菌药物治疗失败的一个重要原因;因此,加强产ESBLs菌株的监测,根据药敏试验科学用药,对控制耐药菌的产生和临床治疗具有十分重要的意义。
OBJECTIVE To analyze the drug resistance of extended spectrum β-lactamase （ESBL）-producing Escherichia coli and Klebsiella pneumoniae causing urinary tract infections so as to guide the reasonable clinical use of antibiotics. METHODS A total of 1019 copies of midstream urine specimens were collected from Jan 2009 to Jul 2010, then the automated microbial analyzer （VITEK-2 Compact） was employed to perform the bacteriologic identification and the drug susceptibility testing, and the ESBL-prodESBL-producingucing bacteria were detected by using the double disc recommended by NCCLS and the phenotypic confirmatory test. RESULTS Totally 254 strains of gram-negative bacilli were isolated from 1019 copies of specimens with the positive rate of 24.9%, among which there were 127 （50.0%） strains of E. coli and 74 （29.1%） strains of K. pneumonia ; there were 50 （39.4%） strains of ESBL-producing E. coli and 33 （44.6%） strains of K. pneumoniae. The ESBL-producing strains and the non-ESBL-produeing strains showed low drug resistance to cefotetan, imipenem, meropenem, and piperacillin/tazobactam,with the drug resistance rate less than 24.2% the ESBL-producing strains were multi- drugCresistant to β-lactams antibiotics, aminoglycosides, quinolones and sulfa drugs; the non-ESBL producing E. coli showed intermediary or resistance; the non-ESBL-producing K. pneumonia showed high drug resistance to ampicillin and piperacillin, with the drug resistance rate more than 97.6%, while the strains showed low resistance to all the antibiotics except for cefuroxime axetil. CONCLUSION The drug resistance rate of the ESBL-producing strains causing urinary tract infections is higher than that of the non-ESBL-producing strains, and the strains are multidrug-resistant, which is the cause of failure of clinical drug therapy. It is of great significance to the control of drug resistant strains and the clinical treatment to strengthen the monitoring of the ESBL-producing strains and use antibiotics based on the drug susceptibility testing.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第18期4529-4531,共3页
Chinese Journal of Nosocomiology
关键词
泌尿系感染
大肠埃希菌
肺炎克雷伯菌
Urinary tract infection
Escherichia coli
Klebsiella pneumonia
