老年人医院内下呼吸道产超广谱β内酰胺酶菌株感染及药敏分析

摘要

Objective To analyze the risk factors of aged patients with nosocomial lower respiratory tract ESBLs producing strain infection and drug sensitivity tests.Methods The underlying diseases and medical causes of 126 aged patients with nosocomial lower respiratory tract ESBLs producing strain (Klebsiella pneumoniae and/or Escherichia coli) infection were statistically analyzed.ESBLs strain was identified by the United States of America BD company Sceptor semi automatic analyzer,and Kirby-Bauer (KB) method was used for drug sensitivity test in vitro.Results All patients had chronic severe basic diseases,chronic lung diseases accounting for 26.19％ (33/126),malignant tumor and brain system diseases were respectively accounting for 21.4％ (27/126),admitted in ICU or CCU accounting for 35.7％ (45/126),the use of broad-spectrum antibiotics accounting for 92.8％ (117/126),the use of nasogastric tube and atomizer accounting for 38.1％ (48/126) and 35.7％ (45/126),mechanical ventilation accounting for 23.8％ (30/126),use of antacids accounting for 30.2％ (38/126).Drug sensitivity test showed that the sensitivity of ESBLs producing strains to imipenem was 100％,the sensitivity of ESBLs producing strains to piperacillin / tazobactam was 78.6％-79.4％,the sensitivity of ESBLs producing strains to cefoxitin was 70.6％-71.5％,the sensitivity of ESBLs producing strains to Amikacin,ticarcillin / clavulanic acid was in general.Conclusions Imipenem,piperacillin/hebatan,cephalosporins drug cefoxitin can be choosed for treatment of ESBLs strains infection.Three generations of cephalosporins and single beta lactam antibiotics should be avoided.Bacteria room should closely cooperate with clinical work.Reasonable use of antibiotics and curb the popularity of ESBLs strains,reduce hospital infection is the top priority.%目的 分析老年人医院内下呼吸道产超广谱β-内酰胺酶(ESBLs)菌株感染的危险因素及药敏试验情况.方法 对126例产ESBLs肺炎克雷伯杆菌、大肠埃希氏菌老年人医院内下呼吸道感染的基础疾病,医源性因素进行统计分析,对判断为ESBLs的菌株采用美国BD公司Sceptor半自动分析仪进行细菌鉴定,并用Kirby-Bauer (KB)法进行体外药敏试验.结果 所有患者都有严重的慢性基础疾病,其中慢性肺科疾病占26.19％ (33/126),恶性肿瘤和脑系科疾病均各占21.4％ (27/126),入住ICU或CCU占35.7％ (45/126),使用广谱抗生素达92.8％ (117/126),使用鼻饲管和雾化器占38.1％ (48/126)和35.7％ (45/126),人工气道机械通气者占23.8％ (30/126),应用制酸剂占30.2％(38/126).药敏监测表明产ESBLs菌株对亚胺培南敏感性达100％,哌拉西林/他唑巴坦敏感性为7 8.6％～79.4％,头孢西丁敏感性为70.6％～71.5％,阿米卡星、替卡西林/棒酸敏感性一般.结论 临床上可以选用亚胺培南、哌拉西林/他唑巴坦、头孢霉素类头孢西丁等作为ESBLs感染菌株的治疗.应避免头孢三代,单环β-内酰胺类抗生素的应用.细菌室应密切配合临床工作.合理应用抗生素,遏制ESBLs菌株的流行,减少医院感染是当务之急.