大肠埃希菌和肺炎克雷伯菌ESBLs检测及耐药性分析

由细菌超广谱β-内酰胺酶（ESBLs）引起的细菌耐药性一直是临床相关感染性疾病治疗中的棘手问题。从不同病区患者标本中分离了96株大肠埃希菌和80株肺炎克雷伯菌，分剐采用双纸片协同试验和药物敏感试验检测了上述菌株产生ESBLs情况及对17种抗生素的耐药性。结果发现，27．1％（26／96）的大肠埃希菌株和22．5％（18／80）肺炎克雷伯菌株产ESBLs。ICU病房分离的大肠埃希菌和肺炎克雷伯菌株ESBLs总阳性率（46．0％）与介入科病房和烧伤科病房分离菌株ESBLs总阳性率（28．6％和25．0％）无显著性差异（P〉0．05），但明显高于呼吸科、骨科、其他病房及门诊部分离菌株ESBLs总阳性率（6．3％～14．3％，P〈0．01）。不产ESBLs大肠埃希菌株和肺炎克雷伯菌株对17种抗生素耐药率明显低于产ESBLs菌株。产ESBLs大肠埃希菌和肺炎克雷伯菌对氨曲南均敏感，对氨苄西林／舒巴坦、阿莫西林／棒酸、阿米卡星耐药率仅为15．8％-23．4％。上述实验结果提示，大肠埃希菌和肺炎克雷伯菌临床菌株中有较高的ESBLs阳性率，不同病区患者感染的大肠埃希菌和肺炎克雷伯菌ESBLs阳性率有很大差异，氨曲南、氨苄西林／舒巴坦、阿莫西林／棒酸、阿米卡星可作为治疗产ESBLs大肠埃希菌和肺炎克雷伯菌感染性疾病的首选药物。

Drug Resistance Analysis and ESBLs Detection in Isolates of Escherichia coli and Klebsiella pneumoniae

Drug resistance caused by bacterial extended-spectrum-β-lactamases （ESBLs） has been a thorny problem in clinic for therapy of associated infectious diseased. 96 Escherichia colt （Ec） strains and 80 Klebsiella pneumoniae （Kp） strains from patients in different endemic areas were isolated. And ESBLs production and resistance to 17 antibiotics of all the strains were detected by double disk synergy test and drug susceptibility test respectively. The results showed that 27.1% （26/96） of the Ec strains and 22.5% （18/80） of Kp strains were ESBLs detectable. The total ESBLs positive rate （46. 0% ） in isolates of the two bacteria from ICU were similar to those from Interventioin （28.6%） and Burn （25.0%） Departments （P 〉 0.05 ） , but much higher than those from Respiratory, Orthopedics, Outpatient Departments and the other endemic areas （6.3% - 14.3% , P 〈 0.01 ）. The resistance rates to 17 antibiotics of the ESBLs strains of Ec and Kp were remarkable lower than those of the ESBLs strains. All the ESBLs strains were sensitive to aztreonam, while their resistance rates to ampicillin / sulbactam, amoxicillin / clavulanic acid and amikacin were lower as 15.8% - 23.4%. All the results of the study indicated that higher ESBLs positive rate existed in isolates of Ec and Kp, the diversity of ESBLs positive rates of the two bacteria from patients in different endemic areas as weft as the first choice to use aztreonam, ampiciilin / sulbactam, amoxicillin / clavulanic acid and amikacin for curing infectious diseases caused by ESBLs strains of Ec and Kp.