产ESBLs、产ESBLs及AmpC酶肺炎克雷伯菌分布及耐药性研究.doc

产ESBLs、产ESBLs及AmpC酶肺炎克雷伯菌分布及耐药性研究[摘要] 目的：了解我院2000年3月～2007年3月产ESBLs、产ESBLs+AmpC酶肺炎克雷伯菌的临床分布及耐药性。方法：采用VITEK-AMS细菌鉴定系统进行细菌鉴定，药敏试验采用KB法，结果分析采用WHONET5软件。结果：检出产ESBLs肺炎克雷伯菌131株，检出率为38.3%，检出产ESBLs+AmpC酶肺炎克雷伯菌76株，检出率为17.6%，尿液与脓液中产ESBLs+AmpC酶菌株、产ESBLs菌株检出率最高；在年龄调查中，71~80岁组产ESBLs、产ESBLs+AmpC酶菌株检出率最高，检出率与年龄大致呈正相关。在耐药性分析中，产ESBLs+AmpC酶菌株较产ESBLs菌株呈现更复杂的多重耐药。结论：产ESBLs+AmpC酶肺炎克雷伯菌的感染在临床已广泛存在，多重耐药明显，临床应及时了解其耐药特点及变化趋势，以便合理使用抗生素。 [关键词] 产ESBLs；产ESBLs+AmpC酶；肺炎克雷伯菌；分布；耐药性 [中图分类号]R446 [文献标识码]B [文章编号]1673-7210（2008）04（a）-088-02 Study on the distribution and drug-risistence of ESBLs-producing、 ESBLs+AmpC-producing K.pneumoniae LI Guan-ding,RONG Yong-zhong (Woman Child Health Hospital of Guangzhou Haizhu District,Guangzhou 510240,China ) [Abstract] Objective:To understand the distribution and drug-risistence of ESBLs-producing、 ESBLs+AmpC-producing K.pneumoniae from March 2000 to March 2007 in our hospital.Methods:The bacteria were determined by VITEK-AMS system.Drug sensitivity tests used KB method,the results was analyzed by WHONET 5. Results:Among the isolates there were 131 strains of ESBLs-producing bacteria(38.3%),76 strains of ESBLs+AmpC-producing bacteria(17.6%).The producing rate in urine and pus in 71~80 ages was the highest.The risistence of the ESBLs+AmpC-producing bacteria to 18 kinds of agents were higher than the ESBLs-producing bacteria. Conclusions:The ESBLs+AmpC-producing K.pnemoniae exist in clinic at a high level and have got the risistence to many kinds of antibiotics.It is important for clinical physicians to understand the distribution and the risistence characteristics to use the antibiotics rationally. [Key words] ESBLs-producin;ESBLs+AmpC-producing;K.pnemoniae；Distribution;Resistance 抗菌药物的大量使用，导致细菌多重耐药问题越来越严重，已引起社会的广泛关注。β-内酰胺类抗生素的临床应用，使革兰阴性杆菌的耐药性更加突出。AmpC酶与超广谱β-内酰胺酶（ESBLs）是造成革兰阴性杆菌对β-内酰胺类抗生素耐药的最主要原因。肺炎克雷伯菌是医院常见的条件致病菌之一。本文收集我院2000年3月~2007年3月分离的342株肺炎克雷伯菌标本，检测其产ESBLs及AmpC酶情况，对产ESBLs及产ESBLs+AmpC酶肺炎克雷伯菌的分布与耐药情况进行了研究，为临床诊疗及用药提供参考。 1材料与方法 1.1