CAJ | 학술논문

目的探讨院内获得性肺炎老年患者产超广谱β-内酰胺酶(ESBLs)病原菌的分布及耐药情况.方法共收集2006年10月-2007年10月上海市杨浦区老年医院和市东医院呼吸科年龄≥65岁的老年患者978例,对其中符合院内获得性肺炎诊断标准的78例进行回顾性分析.结果院内获得性肺炎的发生率为8.0%(78/978),合格痰标本感染病原菌培养阳性率为61.9%(164/265).产ESBLs细菌39株,占革兰阴性菌株数的31.7%;其中大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中产ESBLs菌株的检出率分别为51.5%(17/33)、45.2%(14/31)、17.6%(3/17).大肠埃希菌产ESBLs菌株对氨苄青霉素、哌拉西林、头孢唑啉、头孢呋辛、头孢噻肟和环丙沙星的耐药率均>90%,对氨曲南的耐药率为54.7%,但对头孢他啶、头孢西丁、头孢哌酮-舒巴坦、哌拉两林-他唑巴坦的耐药率均较低.肺炎克雷伯菌产ESBLs菌株对氨苄青霉素、头孢唑啉、头孢呋辛的耐药率均>90%,对头孢噻肟、哌拉西林的耐药率>80%,对氨曲南的耐药率为71.7%,但对头孢西丁、哌拉西林-他唑巴坦的耐药率较低.结论本研究分离出的大肠埃希菌和肺炎克雷伯菌产ESBLs严重,且大多呈多重耐药.如果痰培养分离到大肠埃希菌和肺炎克雷伯菌,且药物敏感试验结果对头孢曲松、头孢噻肟等第三代头孢菌素耐药时,应疑为产ESBLs阳性菌,避免使用第三代头孢菌素;如果药物敏感实验报告革兰阴性菌对三代头孢菌素敏感.但治疗后失败,也应考虑ESBLs阳性菌的产生.
목적 탐토원내획득성폐염노년환자산초엄보β-내선알매(ESBLs)병원균적분포급내약정황.방법 공수집2006년10월-2007년10월상해시양포구노년의원화시동의원호흡과년령≥65세적노년환자978례,대기중부합원내획득성폐염진단표준적78례진행회고성분석.결과 원내획득성폐염적발생솔위8.0%(78/978),합격담표본감염병원균배양양성솔위61.9%(164/265).산ESBLs세균39주,점혁란음성균주수적31.7%;기중대장애희균、폐염극뢰백균화기이변형간균중산ESBLs균주적검출솔분별위51.5%(17/33)、45.2%(14/31)、17.6%(3/17).대장애희균산ESBLs균주대안변청매소、고랍서림、두포서람、두포부신、두포새우화배병사성적내약솔균>90%,대안곡남적내약솔위54.7%,단대두포타정、두포서정、두포고동-서파탄、고랍량림-타서파탄적내약솔균교저.폐염극뢰백균산ESBLs균주대안변청매소、두포서람、두포부신적내약솔균>90%,대두포새우、고랍서림적내약솔>80%,대안곡남적내약솔위71.7%,단대두포서정、고랍서림-타서파탄적내약솔교저.결론 본연구분리출적대장애희균화폐염극뢰백균산ESBLs엄중,차대다정다중내약.여과담배양분리도대장애희균화폐염극뢰백균,차약물민감시험결과대두포곡송、두포새우등제삼대두포균소내약시,응의위산ESBLs양성균,피면사용제삼대두포균소;여과약물민감실험보고혁란음성균대삼대두포균소민감.단치료후실패,야응고필ESBLs양성균적산생.
Objective To investigate the distribution and antibiotic resistance of the extended spectrum lactamases (ESBLs) in older patients with hospital-acquired pulmonary infection. Methods A total of 978 patients who were treated in Yangpu Geriatric Hospital and Shidong Hospital during Oct. 2006 to Oct. 2007 were studied, and 78 patients meeting the hospital acquired pneumonia (HAP) criterion were retrospectively analyzed. Results The incidence of HAP was 7.98% (78/978). The qualified sputum specimen bacterial positive rate was 61.9% (164/265). There were 39 strains of ESBLs bacteria, accounting for 31.7% (39/123)of the gram-negative bacteria. ESBLs-producing strains were positive in 51.5% (17/33) of Escherichia coli, 45.2% (14/31) of Klebsiella pneumoniae, and 17.6% (3/17) of Proteus mirabilis isolates. ESBLs-producing Escherichia coil strains had a >90% resistant rates to Ampicillin Sodium, Piperacillin Ciprofloxacin, Cefuroxime, Cefotaxime, and Cefazolin, and had a resistance rate of 54.7% to Aztreonam, but had a lower resistance rate to Cefoxitin, Cefoperazone/Sulbactam, Piperacillin Sodium and Tazobactam Sodium, Cefoxitine, and Ceftazidime. ESBLs-producing Klebsiella pneumoniae had a >90% resistance rate to Ampicillin Sodium, Cefuroxime, and Cefazolin, a>80% resistance rate to Cefotaxine and Piperacillin, a resistance rate of 71.7% to Aztreonam, and lower resistance rates to Piperacillin/Tazobactam and Cefoxitin. Conclusions The ESBLs producing stains of Escherichia coli and Klebsiella pneumoniae are high in our cohort, and most of them are multiple drugs resistant. ESBLs-producing strains should be suspected when the isolated Escherichia coli and Klebsiella pneumonioe are resistant to third generation cephalosporin, such as Cefotaxime and Ceftriaxone. ESBLs-producing strains should also be suspected when Gram negative strains are sensitive to third generation cephalosporin, but failure in treatment occurs.