| 摘要: |
| 目的：分析我院儿科产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌的临床分布特征及耐药性，为临床合理用药提供参考。方法：对2012年12月至2015年12月在我院儿科住院的感染性疾病患儿送检的标本进行培养，采用VITEK细菌鉴定与药敏分析系统对菌落进行菌种鉴定及药敏分析。结果：临床共分离大肠埃希菌86株，其中产ESBLs菌60株（69.77%），83.33%（50/60）来源于痰液标本；肺炎克雷伯菌62株，其中产ESBLs菌57株（91.94%），92.98%（53/57）来源于痰液标本。产ESBLs大肠埃希菌对美罗培南、环丙沙星、阿米卡星、左氧氟沙星的耐药率分别为0%、1.67%、3.33%、3.33%，对其他抗菌药物的耐药率为5.00%~96.66%；产ESBLs肺炎克雷伯菌对美罗培南、环丙沙星、左氧氟沙星的耐药率均为0%，对其他抗菌药物的耐药率为3.51%~92.98%。结论：产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌主要来源于痰液标本，对常用抗菌药物的耐药情况基本一致（β-内酰胺酶抑制剂复方制剂除外）。二者对大部分头孢菌素耐药率较高（头孢替坦除外），对碳青霉烯类（美罗培南、亚安培南）、氨基糖苷类（阿米卡星、庆大霉素、妥布霉素）、喹诺酮类（左氧氟沙星、环丙沙星）的耐药率较低。临床医师应结合药敏试验结果，合理选用抗菌药物，避免滥用，以减少细菌耐药。 |
| 关键词: ESBLs 大肠埃希菌 肺炎克雷伯菌 临床分布 耐药性 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.12.011 |
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| 基金项目: |
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| Clinical Distribution and Drug Resistance of ESBLs Producing Escherichia Coli and ESBLs Producing Klebsiella Pneumoniae in Our Hospital |
| Wang Zhigang, Zhu Ajin, Fang Xia, Zhang Jinyu, Zeng Xianbin |
| (Nanyang First People’s Hospital, Henan Nanyang 473000, China) |
| Abstract: |
| Objective: To analyse clinical distribution and drug resistance of producing ESBLs E. coli with ESBLs Klebsiella pneumonia bacteria, providing reference for clinical rational drug use. Methods: To culture specimens of pediatric patients in December 2012 to December 2015 in hospital, using VITEK bacterial identification and drug susceptibility analysis system to bacteria identification and drug susceptibility analysis of colony. Results: Producing ESBLs E. coli detection rate was 69.77% in the clinical distribution of 86 strains of E. coli, the sputum specimens were 83.33%. Producing ESBLs Klebsiella pneumonia bacteria detection rate was 91.94% in 62 strains of Klebsiella pneumonia bacteria, including sputum specimens were 92.98%. The irologic resistance of Producing ESBLs E. coli to meropenem, ciprofloxacin, amikacin and ofloxacin were 0.00%, 1.67%, 3.33%, 3.33% respectively, for other antimicrobial resistant rate were 5.00%~96.66%; the irologic resistance of producing ESBLs Klebsiella pneumonia bacteria to meropenem, ciprofloxacin and ofloxacin were 0.00%, 0.00%, 0.00% respectively, for other antimicrobial resistance were 3.51%~92.98%. Conclusion: ESBLs strains of E. coli and ESBLs strains Klebsiella pneumonia bacteria mainly came from sputum samples. Besides beta lactamase, they had the sensitivity of the other classes of drugs had a basic consistency. Besides cefotetan, most of the cephalosporin antibiotics sensitive rate was low, that had a higher resistance on cephalosporin drugs. The sensitive rate of two kinds of germs on imipenem and meropenem of carbapenems were 95.00%~100%, the drug had a good antibacterial effect. Two kinds of bacteria of sensitive rate of amikacin, gentamycin, tobramycin of aminoglycoside drug were good. Two kinds of bacteria to ofloxacin of quinolones and ciprofloxacin of fluoroquinolone drugs had sensitive rate were 98.22%~100%, the drug also had the very good antibacterial effect. All kinds of antibiotics on producing ESBLs E. coli and producing ESBLs Klebsiella pneumonia bacteria resistance analysis and research would have guiding significance for clinical rational drug use. Clinical drug treatment should be combination of medicine sensitive experiment, choose reasonable and effective antimicrobials, reduce the abuse of antibacterial agents and bacteria resistant, improve the curative effect and avoid ineffective treatment. Therefore, it reflected the significance of the clinical drug use combined with drug susceptibility experiment. |
| Key words: ESBLs E. coli Klebsiella pneumonia bacteria clinical distribution drug resistance |
