社区与医院感染中肺炎克雷伯杆菌和大肠埃希菌耐药性分析

目的探讨社区和医院感染中肺炎克雷伯杆菌和大肠埃希菌产ESBLs的情况及耐药特性。方法采用体外扩散确证试验检测ESBLs,同时用Micro scan wat RA way-40系统全自动细菌鉴定/药敏分析仪及K-B琼脂扩散法进行细菌鉴定和体外药敏试验。结果社区感染标本中分离出肺炎克雷伯杆菌79株,产ESBLs20株,阳性率为25.3%,大肠埃希菌177株,产ESBLs27株,阳性率为15.3%;医院感染标本中分离出肺炎克雷伯杆菌82株,产ES-BLs33株,阳性率为40.2%,大肠埃希菌135株,产ESBLs42株,阳性率为31.1%,社区与医院感染菌株产ESBLs比较差异均有统计学意义(P均<0.05);ESBLs阳性菌株对多种抗生素耐药,其耐药性明显高于ESBLs阴性菌株。结论肺炎克雷伯杆菌和大肠埃希菌产ESBLs菌株在临床分离率较高,医院感染标本要显著高于社区感染标本,并且对多种抗生素具有高度耐药性,产ESBLs菌株耐药性显著高于不产ESBLs菌株,临床上应加强对ESBLs的控制,以防感染流行。

The drug resistance of Klebsiella pneumoniae and Escherichia coli from community and hospital infection

Objective To explore the drug resistance and ESBL producing ability of Klebsiella pneumoniae and Escherichia coli isolated from community and hospital infection.Method Diffusion test in vitro was performed to detect ESBLs;Micro scan wat RA-40 of specified automatic identification system bacteria/drug susceptibility analyzer was used for bacterial and fungi identification and K-B AGAR diffusion method for drug susceptibility test in vitro.Result 79 strains of Klebsiella pneumoniae were separated from community infection specimens,including 20 ESBLs positive strains(25.3%).There were 177 strains of Escherichia coli,including 27 ESBLs positive strains(15.3%).82 strains of Klebsiella pneumoniae were isolated from hospital infection specimens,33(40.2%) of which were ESBLs positive;Of the 135 strains of Escherichia coli isolated from hospital specimens,42(31.1%) were ESBLs positive.There was significant difference between the ESBLs producing strains from community infection and hospital infection(P<0.05);ESBLs positive strains had antibiotic resistance significantly higher than ESBLs negative strains.Conclusion ESBLs producing Klebsiella pneumoniae and Escherichia coli have high clinical isolation rate,especially in hospital infection,and higher resistance to many antibiotics than non-ESBLs producing strains,which should be controlled strictly to prevent the prevalence of the infection.