ICU病房产超广谱β-内酰胺酶肺炎克雷伯菌的监测和耐药性分析

摘要

了解产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的耐药性,为临床合理使用抗菌药物提供依据.采用自动化细菌鉴定仪(法国生物梅里埃公司Vitek-2和BD Phonenix 100)进行细菌鉴定和药敏试验,应用WHONETS.4软件进行耐药性分析.ICU病房共分离出100株肺炎克雷伯菌,其中产ESBLs株48株,占48％,药敏结果显示产ESBLs菌株的耐药率普遍高于不产ESBLs株,产ESBLs株对氨苄西林、头孢呋辛、头孢唑啉等全部耐药,对头孢曲松、头孢噻肟的耐药率也大于80％,对氨基糖苷类的庆大霉素、四环素,对喹诺酮类的环丙沙星、左氧氟沙星以及磺胺类中的复方新诺明耐药率较高(均大于55％),对哌拉西林/他唑巴坦、阿米卡星、头孢西丁等耐药率较低,对亚胺培南、美洛培南高度敏感.产ESBLs肺炎克雷伯菌耐药现象严重,及时监测产ESBLs菌的发生率及其耐药趋势,为临床合理应用抗菌药物,延缓细菌耐药性的产生,控制医院感染具有重要意义.%Drug resistance of extended spectrum β-lactamases (ESBLs)-producing Klebsiella pneumoniae (KP) in ICU was studied in order to provide foundation for antibiotics administration. The strains were identified and drug sensitivity tests were carried out by automatic bacteria identification instrument (French made Vitek-2 and BD Phonenix 100 by bioMerieux) and drug sensitivity analyzing systems, then ESBLs producing status and the results of sensitivity to antibiotics were analyzed. The data were analyzed by WHONET 5.4 software. The results showed that 100 KP strains were i-solated from ICU; among them ESBLs producing KP strains was 48, accounted for 48% . Drug sensitivity test results indicated that the drug resistance rate of ESBLs producing strains were universally higher than those non-ESBLs producing strains. All ESBLs producing strains resisted to ampicillin, cefazolin, and cefuroxime, and the resistance rate to ceflri-axone, cefotaxime were above 80% , while the resistance rate to aminoglycosides of gentamicin, tetracycline, to fluoroqi-nolones of ciprofloxacin, levofloxacin, sulfonamides of SMZ-TMP were fairly high (all above 55% ) , and fairly low to piperacillin/tazobactam, amikacin, cefoxilin, but highly sensitive to imipenem and meropenem. Therefore, the drug resistance phenomenon of ESBLs producing KP strains was very serious. Monitoring in time the occurrence of ESBLs producing strains and the drug resistance trends possesses important significance to guide the clinically reasonable use of antibiotic medicines, to delay the generation of bacteria resistance, and to control infection in the hospitals.