中国实验诊断学
中國實驗診斷學
중국실험진단학
CHINESE JOURNAL OF LABORATORY DIAGNOSIS
2015年
5期
765-769
,共5页
产超广谱β-内酰胺酶%大肠埃希菌%肺炎克雷伯菌%医院感染%耐药性
產超廣譜β-內酰胺酶%大腸埃希菌%肺炎剋雷伯菌%醫院感染%耐藥性
산초엄보β-내선알매%대장애희균%폐염극뢰백균%의원감염%내약성
Extended-spectrum-β-lactamases (ESBLs)%Escherichia coli%Klebsiella pneumonia%Hospital infection%Drug Resistance
目的：调查产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌临床分布及耐药性分析，指导临床合理用药。方法收集2011年10月-2014年10月我院住院病人送检各类标本，采用 VITEK-Ⅱ进行细菌鉴定及药敏试验；采用采用 CLSI 推荐的双纸片和表型确证试验检测产 ESBLs 细菌；对阳性患者的抗菌药物应用情况进行调查分析。结果从374株阳性标本检出产 ESBLs 大肠埃希菌和肺炎克雷伯菌172株，总检出率46．0％。276株大肠埃希菌中，检出产 ESBLs 大肠埃希菌132株，检出率为47．8％，检出前第三代抗菌药物使用率81．1％；标本主要从尿液（50．7％）和脓液（16．7％）中检出，科室大多分布于泌尿科病房（40．8％）及普外科病房（12．9％）。98株肺炎克雷伯菌中，检出产ESBLs 肺炎克雷伯菌40株，检出率为40．82％，检出前第三代抗菌药物使用率90．0％；标本主要从痰液（37．5％）和脓液（15．0％）中检出，科室大多分布于内科病房（40．0％）及感染科（12．5％）。产 ESBLs 大肠埃希菌对碳青霉烯类及部分β-内酰胺酶抑制剂复合剂的耐药率分别为6．5％-22．5％，对其他抗菌药物的耐药率分别为36．2％-88.3％。产 ESBLs肺炎克雷伯菌对碳青霉烯类、头孢吡肟、左氧氟沙星及部分β-内酰胺酶抑制剂复合剂的耐药率分别为3．1％-28．5％，对其他抗菌药物的耐药率分别为41．9％-88．8％。大肠埃希菌两组产与非产 ESBLs 菌株对头孢吡肟、亚胺培南、阿米卡星、头孢哌酮／舒巴坦及哌拉西林／他唑巴坦耐药率比较 P＞0．05，差异不具有统计学意义；肺炎克雷伯菌两组产与非产 ES-BLs 菌株对亚胺培南、头孢哌酮／舒巴坦耐药率比较 P ＞0．05，差异不具有统计学意义。结论制定合理有效的感染控制措施，合理使用抗菌药物，避免及减少产超广谱β-内酰胺酶细菌引起医院感染的暴发流行。
目的：調查產超廣譜β-內酰胺酶大腸埃希菌和肺炎剋雷伯菌臨床分佈及耐藥性分析，指導臨床閤理用藥。方法收集2011年10月-2014年10月我院住院病人送檢各類標本，採用 VITEK-Ⅱ進行細菌鑒定及藥敏試驗；採用採用 CLSI 推薦的雙紙片和錶型確證試驗檢測產 ESBLs 細菌；對暘性患者的抗菌藥物應用情況進行調查分析。結果從374株暘性標本檢齣產 ESBLs 大腸埃希菌和肺炎剋雷伯菌172株，總檢齣率46．0％。276株大腸埃希菌中，檢齣產 ESBLs 大腸埃希菌132株，檢齣率為47．8％，檢齣前第三代抗菌藥物使用率81．1％；標本主要從尿液（50．7％）和膿液（16．7％）中檢齣，科室大多分佈于泌尿科病房（40．8％）及普外科病房（12．9％）。98株肺炎剋雷伯菌中，檢齣產ESBLs 肺炎剋雷伯菌40株，檢齣率為40．82％，檢齣前第三代抗菌藥物使用率90．0％；標本主要從痰液（37．5％）和膿液（15．0％）中檢齣，科室大多分佈于內科病房（40．0％）及感染科（12．5％）。產 ESBLs 大腸埃希菌對碳青黴烯類及部分β-內酰胺酶抑製劑複閤劑的耐藥率分彆為6．5％-22．5％，對其他抗菌藥物的耐藥率分彆為36．2％-88.3％。產 ESBLs肺炎剋雷伯菌對碳青黴烯類、頭孢吡肟、左氧氟沙星及部分β-內酰胺酶抑製劑複閤劑的耐藥率分彆為3．1％-28．5％，對其他抗菌藥物的耐藥率分彆為41．9％-88．8％。大腸埃希菌兩組產與非產 ESBLs 菌株對頭孢吡肟、亞胺培南、阿米卡星、頭孢哌酮／舒巴坦及哌拉西林／他唑巴坦耐藥率比較 P＞0．05，差異不具有統計學意義；肺炎剋雷伯菌兩組產與非產 ES-BLs 菌株對亞胺培南、頭孢哌酮／舒巴坦耐藥率比較 P ＞0．05，差異不具有統計學意義。結論製定閤理有效的感染控製措施，閤理使用抗菌藥物，避免及減少產超廣譜β-內酰胺酶細菌引起醫院感染的暴髮流行。
목적：조사산초엄보β-내선알매대장애희균화폐염극뢰백균림상분포급내약성분석，지도림상합리용약。방법수집2011년10월-2014년10월아원주원병인송검각류표본，채용 VITEK-Ⅱ진행세균감정급약민시험；채용채용 CLSI 추천적쌍지편화표형학증시험검측산 ESBLs 세균；대양성환자적항균약물응용정황진행조사분석。결과종374주양성표본검출산 ESBLs 대장애희균화폐염극뢰백균172주，총검출솔46．0％。276주대장애희균중，검출산 ESBLs 대장애희균132주，검출솔위47．8％，검출전제삼대항균약물사용솔81．1％；표본주요종뇨액（50．7％）화농액（16．7％）중검출，과실대다분포우비뇨과병방（40．8％）급보외과병방（12．9％）。98주폐염극뢰백균중，검출산ESBLs 폐염극뢰백균40주，검출솔위40．82％，검출전제삼대항균약물사용솔90．0％；표본주요종담액（37．5％）화농액（15．0％）중검출，과실대다분포우내과병방（40．0％）급감염과（12．5％）。산 ESBLs 대장애희균대탄청매희류급부분β-내선알매억제제복합제적내약솔분별위6．5％-22．5％，대기타항균약물적내약솔분별위36．2％-88.3％。산 ESBLs폐염극뢰백균대탄청매희류、두포필우、좌양불사성급부분β-내선알매억제제복합제적내약솔분별위3．1％-28．5％，대기타항균약물적내약솔분별위41．9％-88．8％。대장애희균량조산여비산 ESBLs 균주대두포필우、아알배남、아미잡성、두포고동／서파탄급고랍서림／타서파탄내약솔비교 P＞0．05，차이불구유통계학의의；폐염극뢰백균량조산여비산 ES-BLs 균주대아알배남、두포고동／서파탄내약솔비교 P ＞0．05，차이불구유통계학의의。결론제정합리유효적감염공제조시，합리사용항균약물，피면급감소산초엄보β-내선알매세균인기의원감염적폭발류행。
Objective To investigate the clinical distribution and drug resistance characteristics of extended-spec-trumβ-lactamases(ESBLs)-producing Klebsiella pneumoniae and Escherichia coli and provide a basis for guiding the rational use of clinical drugs.Methods Pathogens isolated from the specimens of inpatient in our hospital since oct. 2011 to oct.2014 were cultured,pathogens identification and drug susceptibility test were performed using VITEK-2 microorganism analyze system.and the ESBL-prodESBL-producingucing bacteria were detected by using the double disc recommended by NCCLS and the phenotypic confirmatory test.Investigation and analysis of use antibiotics in Patients with positive.Results Among 374 strains of K.pneumoniae and E.coli,totally 172strains of ESBLs-producing isolates were isolated with the totaldetection rate of 46.0%.there were 276 strains of e.coli,among which there were there were 132 (47.8%)strains of ESBL-producing E.coli,Check out before the third generation of antimicrobial usage by 81.1%.Specimens from the urine (50.7%),and pus (16.7%)in the detection,mostly distributed in the urological ward department (40.8%)and general surgery ward (12.9%);there were 98 strains of K.pneumoniae,among which there were there were 40 (40.8%)strains of ESBL-producing K.pneumoniae,Check out before the third generation of antimicrobial usage by 90.0%.The specimen Mainly from the sputum (37.5%)and detection in the pus (15.0%), mainly from medical ward (40.0%)and infection (12.5%).The drug resistance rates of ESBLs-produeing strains of e. coli were 6.5%-22.5 % respectively to carbapene-mase and a part of complex antimicrobial drugs containing β-1actamases inhibitor,but the drug resist-ance rates to the other antimicrobial drugs were 36.2%-88.3%,respectively. The drug resistance rates of ESBLs-produeing strains of K.pneumoniae were 3.1 %-28.5 % respectively to carbapene-mase,cefepime ,levofloxacin and a part ofcomplex antimicrobial drugs containing β-1actamases inhibitor,but the drug resist-ance rates to the other antimicrobial drugs were 41.9%-88.8%,respectively.E.coli in the two groups produced with the producing ESBLs strains with cefepime,imipenem,amikacin,Sulbactam and Cefopcrazone and Piperacillin and Tazobactamis resistance rates to compare is P >0.05,no statistically significant difference,Klebsiella pneumoniae in the two groups produced with the producing ESBLs strains of imipenem,Sulbactam and Cefopcrazone is P >0.05,no statis-tically significant difference.Conclusion Formulate rational and effective infection control measures,rational use of an-tibiotics,avoid and reduce the ultra broad spectrum beta lactamase bacteria causing Hospital infection outbreak.
