中国社区医师
中國社區醫師
중국사구의사
Chinese Community Doctors
2014年
21期
12-13,11
,共3页
超广谱β-内酰胺酶%婴幼儿%大肠埃希菌%感染
超廣譜β-內酰胺酶%嬰幼兒%大腸埃希菌%感染
초엄보β-내선알매%영유인%대장애희균%감염
Extended spectrum beta lactamases%Nurseling%Escherichia coli%Infection
目的：探讨婴幼儿感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的分布特点及药敏情况，指导临床合理选用抗菌药物治疗。方法：2011年12月-2013年12月送检的痰、血液、脑脊液等标本进行一般细菌培养，血液注入小儿中和抗生素血培养瓶，放置BacT/ALERT3D血培养仪培养，用法国生物梅里埃系统鉴定细菌，以K-B法进行药敏分析。结果：共检出大肠埃希菌120株，其中有49株产 ESBLs(40.83%)，其中2012年检出大肠埃希菌52株，有13株产ESBLs(25.0%)；2013年检出大肠埃希菌68株，有36株产ESBLs(52.94%)。118株分离自呼吸道标本(98.33%)，2株分离自血液(1.67%)。49株产ESBLs大肠埃希菌对青霉素类、头孢菌素类100%耐药，对氨苄西林/舒巴坦和替卡西林/克拉维酸的不敏感率分别为73.6%和42.3%；对哌拉西林/他唑巴坦20.6%中度敏感，79.4%敏感，对头孢哌酮/舒巴坦高度敏感，敏感率86.32%。未出现耐亚胺培南或美洛培南菌株。结论：新生儿感染大肠埃希菌以呼吸道标本检出最多， ESBLs阳性率2013年比2012年有明显升高趋势，对β-内酰胺类抗菌药物耐药严重，多重耐药现象不容乐观，临床应根据药敏试验结果合理选用抗菌药物，避免诱导型耐药菌株的产生。
目的：探討嬰幼兒感染產超廣譜β-內酰胺酶(ESBLs)大腸埃希菌的分佈特點及藥敏情況，指導臨床閤理選用抗菌藥物治療。方法：2011年12月-2013年12月送檢的痰、血液、腦脊液等標本進行一般細菌培養，血液註入小兒中和抗生素血培養瓶，放置BacT/ALERT3D血培養儀培養，用法國生物梅裏埃繫統鑒定細菌，以K-B法進行藥敏分析。結果：共檢齣大腸埃希菌120株，其中有49株產 ESBLs(40.83%)，其中2012年檢齣大腸埃希菌52株，有13株產ESBLs(25.0%)；2013年檢齣大腸埃希菌68株，有36株產ESBLs(52.94%)。118株分離自呼吸道標本(98.33%)，2株分離自血液(1.67%)。49株產ESBLs大腸埃希菌對青黴素類、頭孢菌素類100%耐藥，對氨芐西林/舒巴坦和替卡西林/剋拉維痠的不敏感率分彆為73.6%和42.3%；對哌拉西林/他唑巴坦20.6%中度敏感，79.4%敏感，對頭孢哌酮/舒巴坦高度敏感，敏感率86.32%。未齣現耐亞胺培南或美洛培南菌株。結論：新生兒感染大腸埃希菌以呼吸道標本檢齣最多， ESBLs暘性率2013年比2012年有明顯升高趨勢，對β-內酰胺類抗菌藥物耐藥嚴重，多重耐藥現象不容樂觀，臨床應根據藥敏試驗結果閤理選用抗菌藥物，避免誘導型耐藥菌株的產生。
목적：탐토영유인감염산초엄보β-내선알매(ESBLs)대장애희균적분포특점급약민정황，지도림상합리선용항균약물치료。방법：2011년12월-2013년12월송검적담、혈액、뇌척액등표본진행일반세균배양，혈액주입소인중화항생소혈배양병，방치BacT/ALERT3D혈배양의배양，용법국생물매리애계통감정세균，이K-B법진행약민분석。결과：공검출대장애희균120주，기중유49주산 ESBLs(40.83%)，기중2012년검출대장애희균52주，유13주산ESBLs(25.0%)；2013년검출대장애희균68주，유36주산ESBLs(52.94%)。118주분리자호흡도표본(98.33%)，2주분리자혈액(1.67%)。49주산ESBLs대장애희균대청매소류、두포균소류100%내약，대안변서림/서파탄화체잡서림/극랍유산적불민감솔분별위73.6%화42.3%；대고랍서림/타서파탄20.6%중도민감，79.4%민감，대두포고동/서파탄고도민감，민감솔86.32%。미출현내아알배남혹미락배남균주。결론：신생인감염대장애희균이호흡도표본검출최다， ESBLs양성솔2013년비2012년유명현승고추세，대β-내선알류항균약물내약엄중，다중내약현상불용악관，림상응근거약민시험결과합리선용항균약물，피면유도형내약균주적산생。
Objective:To investigate the distribution and drug resistance situation of production of extended spectrum beta lactamase(ESBLs) in escherichia coli infection in infants and young children,to guide the clinical rational use of antimicrobial drugs.Methods:Sputum,blood,cerebrospinal fluid and other specimens from December 2011 to December 2013 underwent general bacterial culture,blood was injected in antibiotics and blood culture bottle.The blood was placed in the BacT/ALERT3D blood culture for culture.Bacteria were identified by the French bioMerieux system.We conducted sensitivity analysis using K-B method.Results:There were 120 strains of escherichia coli,including 49 ESBLs producing strains(40.83%).In 2012,there were 52 strains of escherichia coli,including 13 ESBLs producing strains(25%).In 2013,there were 68 strains of escherichia coli,including 36 ESBLs producing strains(52.94%).118 strains were isolated from respiratory tract(98.33%),and 2 strains were isolates from blood (1.67%).49 ESBLs producing strains of escherichia coli were 100% resistant to penicillins,cephalosporins,and not sensitive rate for ampicillin/subatan and ticarcillin/clavulanic acid was respectively 73.6% and 42.3%.It was the moderately sensitive of 20.6% to piperacillin/tazobactam,and sensitivity was 79.4%.It was highly sensitive to Cefoperazone/sulbactam,sensitive rate was 86.32%.There was no resistance to imipenem or meropenem strains.Conclusion:Detection in respiratory specimens is the most. Compared with 2012,the positive rate of ESBLs is significantly increased in 2013.It has a serious resistance to beta lactam antibiotics.The phenomenon of multiple drug resistance is not optimistic.In clinic,we should select antibiotics reasonably according to the results of drug sensitive test in order to avoid induced resistant strains.
