肠杆菌新解释标准指导临床用药的实用性

采用新旧肠杆菌的2种解释标准,分析肠杆菌的耐药性,比较2种解释标准的临床意义。收集本院2009至2010两年临床分离的912株大肠埃希菌、328株肺炎克雷伯菌,用Kirby-Bauer法作药敏试验,用WO-NET5.4软件先设置CLSI推荐的旧的肠杆菌解释标准,分析耐药性。再设置CLSI推荐的新的肠杆菌解释标准1]修改头孢曲松、头孢他啶、头孢噻肟、氨曲南和亚胺培南的解释标准,分析其耐药性。用肠杆菌旧的解释标准分析常规检测分离出的大肠埃希菌236株产酶株;肺炎克雷伯66株产酶株;产酶株比非产酶株的耐药率高。用新的头孢菌素和氨曲南的解释标准:对于大肠埃希菌头孢曲松的耐药率提高5.2%;头孢他啶提高10.4%;头孢噻肟提高10.2%;氨曲南提高7.1%;对于肺炎克雷伯菌头孢曲松的耐药率提高6.7%;头孢他啶提高4.3%;头孢噻肟提高10.1%;氨曲南提高2.5%;未向临床报产酶株。采用碳青霉烯类抗生素新的解释标准大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药分别提高了0.4%和0.6%,对美罗培南的耐药率分别提高了0.2%和0.6%。新的肠杆菌解释标准更能客观分析肠杆菌的耐药性,对指导临床合理用药,控制耐药株的蔓延更具实用价值。

On Enterobacter New Interpretation Criteria to Guide the Practicality of Clinical Medicine

Both interpretations of old and new standards of Enterobacter,E.coli were adopted to analyze their drug resistance,and compare the clinical significance of both interpretations standard.912 E.coli strains;328 Klebsiella pneumoniae strains clinically isolated in the hospital in two years during 2009~2010 were tested their drug sensitivity with Kirby-Bauer method,and analyze their drug resistance first with software WONET5.4 set up first recommended by CLSI the old standard of Enterobacter explanation.And then set up a new Enterobacteriaceae explanation standard recommended by CLSI to revise the explanation standard of ceftriaxone,ceftazidime,cefotaxime,aztreonam,imipenem to analyze their drug resistance.The results showed that adopting Enterobacter old interpretation standards to analyze routine tested and isolated 236 E.coli strains;66 K.pneumoniae strains,the rate of drug resistant of enzyme-producing strains was higher than non-enzyme-producing ones.However,adopted with new cephalosporins and aztreonam interpretation standards of the resistance rate E.coli against ceftriaxone raised by 5.2%;ceftazidime increased by 10.4%;cefotaxime by 10.2%;aztreonam by 7.1%;for K.pneumoniae ceftriaxone-resistant bacteria increase the rate of 6.7%;ceftazidime by 4.3%;cefotaxime 10.1%;aztreonam by 2.5%;enzyme-producing strains were not reported to the clinic.Drug resistance rate of E.coli and K.pneumoinae adopting new interpretation standard of carbapenem antibiotics of imipenem increased by 0.4% and 0.6% respectively,and drug resistance against meropenem resistance by 0.2% and 0.6% respectively.Therefore,new interpretation standard could more objectively analyze the drug resistance of Enterobacter thus possessed more practical value to guide the clinical administration of drugs to control the spread of drug-resistant strains.