中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
6期
572-575
,共4页
高伟%刘志敏%李筱轶%秦瑾
高偉%劉誌敏%李篠軼%秦瑾
고위%류지민%리소질%진근
重症监护病房%超广谱β-内酰胺酶%肺炎克雷伯菌%大肠埃希菌%耐药性
重癥鑑護病房%超廣譜β-內酰胺酶%肺炎剋雷伯菌%大腸埃希菌%耐藥性
중증감호병방%초엄보β-내선알매%폐염극뢰백균%대장애희균%내약성
ICU%Extended-spectrum β-lactamases%Klebsiella pneumoniae%Escherichia coli%Drug resistance
目的 了解重症监护病房(ICU)超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌和大肠埃希菌的检出率及耐药情况,为临床抗感染治疗提供依据.方法 对我院ICU 2008年1月至2010年12月住院患者分离出的肺炎克雷伯菌和大肠埃希菌,采用NCCLs推荐的纸片扩散表型确证试验进行ESBLs细菌的检测,药敏试验采用琼脂扩散(K.B)法.结果 90株肺炎克雷伯菌和大肠埃希菌中检出产ESBLs菌49株,总检出率为54.4%(49/90);其中肺炎克雷伯菌产ESBLs检出率为52.5%(31/59);大肠埃希菌产ESBLs检出率为58.1%(18/31);以呼吸道标本的检出率最高,占75.5%(37/49).产ESBLs菌对青霉素类和头孢菌素类抗菌药物均高度耐药,对氨基糖苷类、喹诺酮类等呈多重耐药,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁、阿米卡星的耐药率均较低;对亚胺培南全部敏感.产ESBLs菌株对抗菌药物的耐药率明显高于非产ESBLs菌株.结论 ICU内产ESBLs肺炎克雷伯菌和大肠埃希检出率较高,对大多数抗菌药物耐药且呈多重耐药性,亚胺培南是治疗产ESBLs菌感染的首选药物.及时检测ICU内产ESBLs菌及其耐药情况对指导临床用药至关重要.
目的 瞭解重癥鑑護病房(ICU)超廣譜β-內酰胺酶(ESBLs)肺炎剋雷伯菌和大腸埃希菌的檢齣率及耐藥情況,為臨床抗感染治療提供依據.方法 對我院ICU 2008年1月至2010年12月住院患者分離齣的肺炎剋雷伯菌和大腸埃希菌,採用NCCLs推薦的紙片擴散錶型確證試驗進行ESBLs細菌的檢測,藥敏試驗採用瓊脂擴散(K.B)法.結果 90株肺炎剋雷伯菌和大腸埃希菌中檢齣產ESBLs菌49株,總檢齣率為54.4%(49/90);其中肺炎剋雷伯菌產ESBLs檢齣率為52.5%(31/59);大腸埃希菌產ESBLs檢齣率為58.1%(18/31);以呼吸道標本的檢齣率最高,佔75.5%(37/49).產ESBLs菌對青黴素類和頭孢菌素類抗菌藥物均高度耐藥,對氨基糖苷類、喹諾酮類等呈多重耐藥,對哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦、頭孢西丁、阿米卡星的耐藥率均較低;對亞胺培南全部敏感.產ESBLs菌株對抗菌藥物的耐藥率明顯高于非產ESBLs菌株.結論 ICU內產ESBLs肺炎剋雷伯菌和大腸埃希檢齣率較高,對大多數抗菌藥物耐藥且呈多重耐藥性,亞胺培南是治療產ESBLs菌感染的首選藥物.及時檢測ICU內產ESBLs菌及其耐藥情況對指導臨床用藥至關重要.
목적 료해중증감호병방(ICU)초엄보β-내선알매(ESBLs)폐염극뢰백균화대장애희균적검출솔급내약정황,위림상항감염치료제공의거.방법 대아원ICU 2008년1월지2010년12월주원환자분리출적폐염극뢰백균화대장애희균,채용NCCLs추천적지편확산표형학증시험진행ESBLs세균적검측,약민시험채용경지확산(K.B)법.결과 90주폐염극뢰백균화대장애희균중검출산ESBLs균49주,총검출솔위54.4%(49/90);기중폐염극뢰백균산ESBLs검출솔위52.5%(31/59);대장애희균산ESBLs검출솔위58.1%(18/31);이호흡도표본적검출솔최고,점75.5%(37/49).산ESBLs균대청매소류화두포균소류항균약물균고도내약,대안기당감류、규낙동류등정다중내약,대고랍서림/타서파탄、두포고동/서파탄、두포서정、아미잡성적내약솔균교저;대아알배남전부민감.산ESBLs균주대항균약물적내약솔명현고우비산ESBLs균주.결론 ICU내산ESBLs폐염극뢰백균화대장애희검출솔교고,대대다수항균약물내약차정다중내약성,아알배남시치료산ESBLs균감염적수선약물.급시검측ICU내산ESBLs균급기내약정황대지도림상용약지관중요.
Objective To analyse the detection rates and antibiotic resistance of extended-spectrum β-lactamases (ESBLs) producing Klebsiella pneumonia and Escherichia coli in Intensive Care Unit (ICU) and to guide the clinical administration of treatment Methods Klebsiella pneumonia and Escherichia coli collected from clinical samples from January 2008 to December 2010 were tested by Phenotypic Confirmatory Test and confirmed by the method advised by NCCLs and drug-sensitivity was tested with K-B. Results Among the isolated 90 samples,49 strains were considered ESBLs-producing bacteria (54.4%) .with 52. 5% (31/59)of Klebsiella pneumonia and 58. 1% (18/31) of Escherichia coli respectively; with the specimens of respiratory system having the highest rate of 75. 5% (37/49). ESBLs producing bacteria were highly resistant to penicillins and cephalosporins, multi drug resistant to aminoglycosides and quinolones; low to piperacillin/tazobactam,cefoperazone/sulbactam,cefoxitin and amikacin; and all sensitive to imipenem. When compared to non-ESBLs producing strains, the rates of antibiotic resistance of the producing ESBLs strains were significantly higher. Conclusion The test results showed that the isolation rates of ESBLs-producing Klebsiella pneumoniae and Escherichia coli in ICU were high,which had high resistance to most antimicrobial agents,and the resistance was multiple. Imipenem could be the best choice to control the infection due to ESBLs-producing organisms. Timely detection of ESBLs producing bacteria and drug resistance is essential to guide clinical antibiotic using in ICU.
