医学论文-我院产ＥＳＢＬｓ大肠埃希菌和肺炎克雷伯菌的耐药性分析.docVIP

医学论文-我院产ＥＳＢＬｓ大肠埃希菌和肺炎克雷伯菌的耐药性分析 ??? [摘要] 目的：了解我院产ESBLs大肠埃希菌和肺炎克雷伯菌的分布及耐药情况，指导临床合理用药。方法：对我院2005年7月～2007年12月的临床标本分离的大肠埃希菌218株，肺炎克雷伯菌195株，采用纸片扩散表型确证试验进行ESBLs检测，用K-B法做药敏试验。结果：在413株菌中共检出产ESBLs菌株106株，总检出率为25.7%；产ESBLs细菌对所有青霉素类抗生素产生耐药，对三代头孢类抗生素耐药率也达到90%以上，对磺胺类、喹诺酮类耐药率为50%～90%，对亚胺培南均敏感。结论：产ESBLs的大肠埃希菌和肺炎克雷伯菌逐年上升，应根据药敏结果结合临床合理使用抗生素。 　　[关键词] ESBLs；大肠埃希菌；肺炎克雷伯菌；耐药性 　　[Abstract] Objective： To study the distribution and characteristic about antibiotic resistance of extended-spectrum β-lactamases(ESBLs) producing Klebsiella pneumoniae and Escherichia coli for guiding the clinical drug using. Methods： 218 isolates of E. coli and 195 isolates of K. pneumoniae strains were collected from July 2005 to December 2007. ESBLs-producing isolates were detected by inhibitor-potentiated disc diffusion test. The bacterial susceptibility testing was done by K-B argr diffusion method. Results： Among 413 E. coli and K. pneumoniae isolates, 106 were ESBLs-producing strains, the ratio was 25.7%. All of the ESBLs producing strain were resistant to penicillins,the resistant rate of 3rd cephalosporin were above 90%,the resisitant rate of sulfonamides and quinolones were 50%～90%,all isolates were susceptble to imipenem.Conclusion:The prevalence of ESBLs-producing E. coli and K. pneumoniae seems increasing, it is very important to use antibiotics reasonably and adopt effcitive measure in clinical.　　[Key words] ESBLs; Escherichia coli; Klebsiella pneumoniae;Antibiotic resistance　　　　目前，随着三代抗生素的应用，产ESBLs的细菌越来越多，大肠埃希菌和肺炎克雷伯菌是最常见的产ESBLs细菌。产ESBLs细菌是由质粒介导，由普通的β-内酰胺酶基因突变产生，并可通过结合、转化、转导等形式使耐药基因在细菌间扩散，因此，产ESBLs细菌感染已成为目前全球共同关注的重要问题[1，2]。为了解我院产ESBLs的大肠埃希菌和肺炎克雷伯菌的分布和耐药情况，我们对我院2005年7月～2007年12月临床分离到的大肠埃希菌和肺炎克雷伯菌ESBLs的检出率和抗菌药物的耐药性进行监测，现报道如下：　　1材料与方法　　1.1标本来源 　　我院2005年7月～2007年12月临床各类标本中分离的大肠埃希菌218株，肺炎克雷伯菌195株，质控菌株ATCC25922，肺炎克雷伯菌ATCC700603。　　1.2细菌鉴定　　应用法国生物梅里埃公司API鉴定系统进行菌株鉴定。　　1.3方法　　1.3.1药敏试验药敏试验方法采用标准纸片扩散法（K-B法）　　1.3.2产ESBLs检测按照NCCLS推荐的ESBLs表型筛选和确证试验方法进行操作。首先用头孢噻肟、头孢他啶、头孢曲松、氨曲南等药敏纸片进行初筛，抑菌圈直径头孢他啶≤22 mm、氨曲南