CAJ | 학술논문

目的：分析该院产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌(ECO)与肺炎克雷伯菌(KPN)的临床分布及对抗菌药物的敏感情况。方法收集该院2013年4月至2014年12月住院患者送检的标本进行分离培养,用 VITEK2 compat 全自动细菌分析仪进行鉴定及药敏试验,对产 ESBLs 的 ECO 和 KPN 进行表型确认试验,并对其临床分布及耐药性进行分析。结果1576株 ECO 与 KPN 中共分离出306株产 ESBLs 菌株和343株多药耐药菌,检出率分别为19.4%和21.8%。576株 ECO 中分离出177株产 ESBLs 菌株和202株多药耐药菌,检出率分别为30.7%和35.1%,未检出泛耐药株,主要从尿液(39.5%)标本中检出,并主要来自于 ICU(37.3%)和外科(29.9%)病区。1000株 KPN 中分离出129株产 ESBLs 菌株,141株多药耐药菌和4株泛耐药菌,检出率分别为12.9%、14.1%和0.4%,主要从痰液(83.7%)标本中检出,并主要来自于 ICU(42.6%)和内科(29.5%)病区。ECO 的产 ESBLs 和多药耐药菌的检出率高于 KPN,差异有统计学意义(P <0.05)。产 ESBLs 的 ECO 与 KPN 对碳青霉烯类的亚胺培南、氨基糖苷类的阿米卡星和复方制剂的哌拉西林/他唑巴坦的敏感性好,对其他抗菌药物的耐药率基本上在50.0%以上。结论产 ESBLs 的 ECO 主要引起泌尿道感染,KPN 主要引起呼吸道感染。产 ESBLs 的 ECO 与 KPN 检出率较高,且多药耐药现象严重,临床应加强产 ESBLs 菌株的耐药监测,并依据药敏结果,规范合理使用抗菌药物,并加强抗菌药物的管理,延缓细菌耐药情况的发生。
목적：분석해원산초엄보β-내선알매(ESBLs)적대장애희균(ECO)여폐염극뢰백균(KPN)적림상분포급대항균약물적민감정황。방법수집해원2013년4월지2014년12월주원환자송검적표본진행분리배양,용 VITEK2 compat 전자동세균분석의진행감정급약민시험,대산 ESBLs 적 ECO 화 KPN 진행표형학인시험,병대기림상분포급내약성진행분석。결과1576주 ECO 여 KPN 중공분리출306주산 ESBLs 균주화343주다약내약균,검출솔분별위19.4%화21.8%。576주 ECO 중분리출177주산 ESBLs 균주화202주다약내약균,검출솔분별위30.7%화35.1%,미검출범내약주,주요종뇨액(39.5%)표본중검출,병주요래자우 ICU(37.3%)화외과(29.9%)병구。1000주 KPN 중분리출129주산 ESBLs 균주,141주다약내약균화4주범내약균,검출솔분별위12.9%、14.1%화0.4%,주요종담액(83.7%)표본중검출,병주요래자우 ICU(42.6%)화내과(29.5%)병구。ECO 적산 ESBLs 화다약내약균적검출솔고우 KPN,차이유통계학의의(P <0.05)。산 ESBLs 적 ECO 여 KPN 대탄청매희류적아알배남、안기당감류적아미잡성화복방제제적고랍서림/타서파탄적민감성호,대기타항균약물적내약솔기본상재50.0%이상。결론산 ESBLs 적 ECO 주요인기비뇨도감염,KPN 주요인기호흡도감염。산 ESBLs 적 ECO 여 KPN 검출솔교고,차다약내약현상엄중,림상응가강산 ESBLs 균주적내약감측,병의거약민결과,규범합리사용항균약물,병가강항균약물적관리,연완세균내약정황적발생。
Objective Analysis of clinical distribution and susceptibility to antimicrobial agents in producing extended spectrumβ-lactamases (ESBLs)of Escherichia coli(ECO)and Klebsiella pneumoniae (KPN).Methods The samples from 2013 April to 2014 December in Changji Prefecture People′s Hospital were cultured and identified,drug sensitivity test did by VITEK2compat au-tomatic bacteria analysis,phenotypic confirmatory test was did on producing ESBLs ECO and KPN,and the clinical distribution and drug resistance was analyzed.Results 1 576 strains of ECO and KPN isolated 306 strains of producing ESBLs strains and 343 strains of multi drug resistant bacteria,the isolation rates were 1 9.4% and 21.8% respectively.In 576 strains of ECO,there were 1 77 strains of producing ESBLs strains and 202 strains of multi drug resistant bacteria were isolated,the separation rates were 30.7% and 35.1% respectively,generic drug resistant strains were not found,and those producing ESBLs strains were isolated mainly from the urine specimens (39.5%),and mainly from the ICU (37.3%)and (29.9%)the surgical ward.There were 129 strains of producing ESBLs strains,141 strains of multi drug resistant bacteria and 4 generic drug resistant strains were isolated from 1 000 strains of KPN,the separation rates were 12.9%,14.1% and 0.4% respectively,and those producing ESBLs strains were isolated mainly from sputum specimens (83.7%),and mainly from the ICU (42.6%)and(29.5%)in the department of inter-nal medicine.Isolation of producing ESBLs ECO and multi drug resistant bacteria were higher than KPN,the difference were statis-tically significant (P <0.05).The sensitivities of ECO and KPN ESBLs strains to carbapenems imipenem andaminoglycosides ami-kacin and compound preparation piperacillin/tazobactam were good,the other antimicrobial drug resistance rates were more than 50.0%.Conclusion ESBLs ECO mainly causes urinary tract infections,KPN mainly causes respiratory tract infection.Detection rates of producing ESBLs ECO and KPN were high,and the multi drug resistance is serious,should strengthen the monitoring of drug resistance on producing ESBLs strains,and according to the results of drug susceptibility,standardize the rational use of anti-microbial agents,and to strengthen the management of antimicrobial agents,delay the occurrence of bacterial resistance.