摘要
目的 :分析产ESBLs(超广谱 β内酰胺酶 )的常见肠杆菌科细菌的耐药性及耐药特点以及病人感染产ES BLs菌的危险因素 ,以指导临床用药。方法 :用K -B法作药敏试验 ,并按NCCLS规定的表型确认实验检测14 0株肠杆菌科细菌是否产ESBLs。结果 :在检测的 14 0株肠杆菌科细菌中 ,ESBLs总阳性率为 36 .4 % ,大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌的产酶率分别为 33.3%、35 .0 %、4 2 .5 %。产ESBLs菌对 11种抗生素 (妥布霉素、庆大霉素、阿米卡星、诺氟沙星、氧氟沙星、环丙沙星、头孢他啶、头孢噻肟、头孢曲松、哌拉西林、复方新诺明 )的耐药率与不产ESBLs菌相比有显著差异 (χ2 检验 ,P <0 .0 5 )。对四种抗生素 (泰能、哌拉西林 /他唑巴坦、阿莫西林 /舒巴坦、舒普松 )的耐药率与不产ESBLs菌相比较无显著差异 (χ2 检验 ,P >0 .0 5 )。产ES BLs菌与不产ESBLs菌对泰能的耐药率分别为 1.9%和 0。各病区产ESBLs菌的分离率以重症监护病房ICU最高 (5 5 .1% ) ,其次是呼吸科病房 (4 2 .0 % )、神经内科病房 (39.1% )、其他病房 (15 .4 % )、干部病房 (12 .5 % )、门诊部 (7.2 0 /5 )。结论 :治疗产ESBLs菌引起的感染应选用泰能、头霉素类以及含 β -内酰胺酶抑制剂的复合物。ICU病房是产ESBLs的高发区 ,呼吸科病房和?
Objective:To determine the productive rates of ESBLs(Extended Specturm β-Lactam-ase) in the clinical isolates of Enterobacteriaceae and investigate the antibiotic resistance of these strains,and investigate the risk factors for infection with ESBLs -producing Enterobaceriaceae.Methods:140 strains of Enterobacteriaceae were determined by a disk diffusion confirmatory test of NCCLS.Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion method. Results:In this sample,the productive rate was 36.4%. the productive rate of E.coli, E.cloacae and K.pneumoniae were respectively 33.3%, 35.0%, 42.5%. The resistance rate of ESBLs-producing strains to eleven kinds of antibiotics (Tobyamycin,Gentamycin, Amikacin, Norfloxacin, Oflxacin, Ciprofloxacin, Ceftazidime, Cefotaxime, Ceftriaxone, Piperacillin, SMZ/TMP(Suifamethoxazole/Trimethoprin) was higher than that of non-ESBLs-producmg strains, There were significant differences between them (χ 2 test, P <0.05).there were not significant differences between the resistance rate of ESBLs-producing stratus to four kinds of antibiotics (Imipenum, Piperacillin/Tazobactam, Amoxicillin/Clavulanic acid, Cefoperazone/sulbactam) and that of non-ESBLs-producing strains (χ 2 test, P >0.05).The resistance rate of ESBLs-producmg strains and non-ESBLs-producing strains to Imipenum were respectively 1.9% and 0 The wards isolated rate of ESBLs-producing strains, in the following order .55.1% in ICU (intense care unit) wards, 42.0% in respiratory system wards, 39.1% in neurologywards, 15.4% in other wards, 12.5% in geriatric wards, 7.2% in outpatient department. Conclusions: To deal with ESBLs-producing Enterobacteroaceae infection, Imipenum, Cephomycm and β-Lactamase inhibitor combinations can be used. ICU had the highest isolated rate of ESBBLs, respiratory system wards and neurology wards had the higher isolated rate of ESBLs, ESBLs-producing enterobacteriaceae was easy to infect in such patients: the long-period use of the third-generation Cephasporins and immunosuppressive drags;having chronic consumptive diseases and of hypoimmunity, had been operated with invasive procedures and manipulations, it is suggested that the doctors should select the antibiotics strictly according to the antibiotic susceptibility and be careful to use the third-generation cephalosporms.
出处
《中国现代医学杂志》
CAS
CSCD
2003年第9期61-64,共4页
China Journal of Modern Medicine
