大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率与耐药性分析_临床医学论文.docVIP

大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率与耐药性分析_临床医学论文 大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率与耐药性分析_临床医学论文 作者：周雨, 程曦, 彭燕, 毛雁飞 【摘要】 目的 了解重庆地区2种常见肠杆菌科细菌(大肠埃希菌、肺炎克雷伯菌)产ESBLs菌株的检出率及细菌耐药性分析。方法 用梅里埃ATB Expression进行菌种鉴定及药敏实验,用纸片扩散法检测ESBLs,并用梅里埃ATBplus软件系统作统计学分析。结果 大肠埃希菌ESBLs阳性检出率为65.41%(121/185),肺炎克雷伯菌ESBLs阳性检出率为40.87%(47/115)。大肠埃希菌对美洛培南和亚胺培南耐药率为零;对头孢菌素类耐药率呈上升趋势;对青霉素类耐药率大于95%,加酶抑制剂后耐药率明显降低;肺炎克雷伯菌耐药谱与大肠埃希菌相似,但其耐药率略低。结论 医院及时监测产 ESBLs 菌的发生率及其耐药趋势以指导临床用药至关重要。 【关键词】 超广谱β内酰胺酶(ESBLs); 抗生素; 大肠埃希菌; 肺炎克雷伯菌 【Abstract】 Objective To investigate detection rate of two common strains of Enterobacteriaceae (Escherichia.coli and Klebsiella.pneumoniae) producing extendedspectrum βlactamases(ESBLs) and to analyze their drugresistance.Methods BiologicalMerieux ATB Expression was taken for strains identification and antimicrobial susceptibility test.The detection of ESBLs was confirmed by disk diffusion method,and the results were statistically analyzed by Merieux ATBplus software.Results A total of 121 strains were ESBLs positive out of 185 strains of E.Coli,and the positive rate was 65.41%;a total of 47 strains were ESBLs positive out of 115 strains of Klebsiella.pneumoniae,and the positive rate was 40.87%.The resistant rates to meropenem and imipenem in Escherichia.coli were zero while the resistant rates to cephalosporins had a rising tendency.The resistant rate to penicilins was higher than 95%,but it depressed obviously after enzyme inhibitor was added.The drugresistant spectrum of Klebsiella.pneumoniae was similar to Escherichia.Coli although its resistant rate in general was a little lower than that of E.Coli.Conclusion Monitoring the incidence of ESBLsproducing strains and their drugresistant trend is essential to guide clinical administration.【Key words】 extendedmoniae 　　肠杆菌科细菌在临床实验室分离菌株中数量占50%左右,也是引起多种疾病感染的常见病原菌[1]。随着抗菌药物在临床的广泛使用,特别是三代头孢菌素在临床广泛使用,大量耐药菌株不断出现,如:产ESBLs菌株、产AmpC菌株,这给临床用药带来诸多困难。大肠埃希菌和肺炎克雷伯菌作为肠杆菌科两种最为常见的细菌,其抗菌药物的耐药性分析研究对临床合理、正确使用抗菌药物具有重要意义。本研究对我院2007年12月～2008年11月临床各类标本分离获得的185例大肠埃希菌和115例肺炎克雷伯菌进行E