肺炎克雷伯杆菌超广谱β－内酰胺酶检测及耐药性分析

Detection of extended-spectrum β-lactamases and analysis of antibiotic resistance in clinical isolates of klebsiella pneumonia

关键词:  肺炎克雷伯菌  超广谱β内酰胺酶  耐药性

Key words:  Klebsiella pneumoniae  ESBLs  Drug resistance

摘要:

了解大连市肺炎克雷伯杆菌产超广谱β－内酰胺酶（ESBLs）菌的发生率及耐药特点。［方法］ 收集并分离临床标本，按美国临床实验室标准化委员会（NCCLS）推荐的纸片扩散初筛法及确证法测定ESBLs ［1］。采用二倍琼脂稀释法，测定13种抗生素对所有菌株的MIC，将产ESBLs和不产ESBLs肺炎克雷伯杆菌的耐药性进行对比分析。［结果］ 临床共分离出肺炎克雷伯杆菌125株，从中筛选出产ESBLs菌34株，检出率为27.2%。二倍琼脂稀释法测定结果表明，所有产ESBLs的肺炎克雷伯杆菌对亚胺培南及美罗培南敏感，敏感率达100％。头孢哌酮/舒巴坦和头孢吡肟对产ESBLs菌株的体外敏感性也很好。产ESBLs的肺炎克雷伯杆菌对阿米卡星（44.1%）和环丙沙星（44.1%）耐药率较高。ESBLs产生株对除了碳青霉烯类抗生素、头孢哌酮/舒巴坦外的其余抗菌药物的耐药率显著高于非ESBLs产生株（P＜0.01）。［结论］ 大连市肺炎克雷伯杆菌产ESBLs的情况比较严重，应采取积极有效措施来迎接ESBLs的挑战。

Abstract:

To collecte 125 strains of Klebsiella pneumoniae isolated from November 2001 to January 2003, determined the prevalence of strains producing ESBLs among Klebsiella pneumoniae and investigated the antibiotices resistance of these strains. ［Methods］ Klebsiella pneumoniae were isolated from clinical specimens, and identified by API system. The minimal inhibitory concentration of 13 kinds of antibiotics was examined by microdilution. We compared the resistant rates of ESBLs-producing strains and non-ESBLs-producing strains to 13 kinds of antibiotics. ［Results］ Total of 34 isolates of 125 nonrepeated strains were ESBLs positive, the productive rate of ESBLs was 27.2%. All of ESBLs-producing strains were susceptible to imipenem and meropenem. Imipinem and meropenem were the most effective antibiotics to infections caused by ESBLs-producing strains. We can also select beta-lactama/beta-lactamase inhibitor combinations, cefoxitin to deal with the ESBLs-producing strains.ESBLs-producing strains had higher resistance rate to aminoglycosides and quinolones. Resistance rates to amikacin and ciprofloxacin were 44.1% and 44.1% respectively. Except imipinem, meropenem, cefoperazone/sulbactam and cefoxitin, the resistant rates of ESBLs-producing strains to the other antibiotics were much highter than that of non-ESBLs-producing strains (P<0.01).［Conclusions］ The prevalence of ESBLs in clinical isolated of klebsiella pneumoniae in our hospital was high, it is necessary for clinical laboratory to detect ESBLs in clinical isolates of klebsiella pneumoniace routinely.