ICU病房痰标本中超广谱β-内酰胺酶菌株的检测及耐药性分析.DOCVIP

临床医学论文-ICU病房痰标本中超广谱β-内酰胺酶菌株的检测及耐药性分析 【关键词】? ICU病房 【摘要】 目的 了解我院ICU病房送检标本中超广谱β-内酰胺酶（ESBLs）细菌的检出率及耐药情况，指导临床医生合理有效地使用抗生素。方法 对我院1999年12月～2003年12月入住ICU患者送检的痰标本进行常规微生物培养及药敏试验，应用双纸片协同试验检测ESBLs。结果 共检出病原菌406株，其中G - 杆菌293株，占72.2%，G + 球菌96株占23.6%，真菌17株。ESBLs总阳性率为14.7%，其中肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌的ESBLs检出率分别为25.4%、21.9%及9.2%。亚胺培南对所有产ESBLs菌表现出最强抗菌作用，头孢西丁对产ESBLs肺炎克雷伯菌及大肠埃希菌有较强的抗菌作用。其他产ESBLs菌对其全部耐药，氨基糖苷类及喹诺酮类抗菌药物对产ESBLs肺炎克雷伯菌表现出较好的抗菌作用。结论 我院ICU病房产ESBLs菌的检出率较高，对产ESBLs G - 菌引起的感染，亚胺培南可作为首选药物。 关键词 ICU病房 超广谱β-内酰胺酶 G - 杆菌 耐药性 【Abstract】 Objective To investigate the situation of the detective ratio of extended-spectrumβ-lactamases production in strains isolated from patients inICU room，to help the doctors to select the optimal antibiotics.Methods This bacteria investigation was carried out in patients in ICU from1999to2003.The bacterial culture、the drug susˉceptibility and a double-disk synergy test were carried out.Results 406strains were cultured in which293strains（72.6%）were G-bacilli and there were43（14.7%）strains producing ESBLs.The productive rate of ESBLsin Klebsiella pneumonia，Escherichia coli and Enterbacter were25.4%，21.9%and9.2%.Imipenem had the most powerful antibacterial activity to all the strains producing ESBLSs.Cefoxitin had more antibacterial activity to Klebsielˉla pneumoniae and Escherichia coli producing ESBLs，However，other strains producing ESBLs were all resistant to ceˉfoxitin，aminoglycosides and fluoroquinolones showed better activity to Klebsiella pneumoniae producing ESBLs.Conˉclusion Isolation rate of ESBLs strains in ICU roomwas high.Imipenem could be the first choice to treat the infection due to drug-resistant strains producing ESBLs. Key words intensive care unit super spectrumβ-lactamase Gram negative bacillus drug resistance 入住ICU病房是ESBLs产生的危险因素之一，ESBLs是革兰阴性杆菌对β-内酰胺类抗生素耐药的重要机制，尤其近年出现的质粒介导的超广谱β-内酰胺酶因其底物谱广、传播速度快而引起国内外学者的高度重视。笔者对我院1999～2003年入住ICU患者送检标本分离出的肠杆菌科细菌进行ESBLs检测，并对其进行部分药物敏感试验，现报告如下。 1 材料与方法 1.1 菌株来源 菌株分离于我院1999年12月～2003年12月入住ICU患者送检的合格痰标本389份，男78例，女311例，年