肠杆菌科细菌产超广谱β.docVIP

呼吸道感染患者肠杆菌科细菌产超广谱β-内酰胺酶情况和药敏监测 作者：邓玉丽， 蔡志军 作者单位：广东省湛江市第二人民医院检验科， 广东 湛江 524003 【摘要】 目的：了解呼吸道感染患者肠杆菌科细菌产超广谱β-内酰胺酶（ESBLs）菌株的检出率及对常用抗生素的耐药情况。方法：收集呼吸道感染患者痰标本中分离出的肠杆菌科细菌326株，用标准纸片扩散法检测ESBLs，用K-B琼脂扩散法做药敏试验。结果：326株肠杆菌科细菌中，共检出产ESBLs菌109株，检出率为33.4%，其中肺炎克雷伯菌63株（37.1%），大肠埃希菌36株（35.6%）。除亚胺培南外，产ESBLs菌对其他常用抗生素的耐药率显著高于非产ESBLs菌。亚胺培南对ESBLs全部敏感，头孢哌酮/舒巴坦耐药率较低，其余抗生素耐药率均较高。结论：呼吸道感染患者痰中肠杆菌科细菌产ESBLs情况严重，临床实验室有必要常规检测ESBLs。亚胺培南是治疗产ESBLs菌感染的有效抗生素。 【关键词】 呼吸道感染； 肠杆菌科； 超广谱β-内酰胺酶； 耐药性 　　Detection and Drug Sensitivity of Enterobacteriaceae Producing Extended Spectrum β-lactamases in Respiratory Tract Infection 　　DENG Yu-li, CAI Zhi-jun 　　(The Second Peoples Hospital of Zhanjiang, Guangdong Zhanjiang 524003, China) 　　Abstract：Objective：To detect production of enterobacteriaceae producing extended spectrum β-lactamases (ESBLs) in respiratory tract infection and drug–resistance to 10 kinds of antibacterial drugs. Method: Disc confirmatory test was used to detect ESBLs in 326 strains of enterobacteriaceae; Kirby—Bauer agar diffusion method was used to judge drug sensitivity. Result: In this sample , productive rate of ESBLs was 33.4%, and productive rate of ESBLs in Klebsiella pneumonia and escherichia coli was 37.1% and 35.6%. The ESBLs-producing strains had very high drug-resistance rate for the all antibiotics except for imipenem . The resistant rates of cefoperazone/sulbactam to ESBLs-Producing strains were the lower. Conclusion: The prevalence of ESBLs in isolates of enterobacteriaceae in respiratory tract infection; it is necessary for clinical laboratory to detect ESBLs in isolates of enterobacteriaceae routinely. Imipenem was the effective antibiotics to infections caused by ESBLs-producing strains . 　　Key words： Respiratory tract infection； Enterobacteriaceae; Extendedspectrum β-lactamases； Antibiotic resistance 　　革兰氏阴性菌是呼吸道感染的主要病原菌。随着第三代头孢类抗生素的广泛应用，出现了新一代的耐药菌株，给呼吸道感染的治疗带来很大的困难，导致菌群耐药的主要机制是细菌染色体或质粒介导的超广谱β-内酰胺酶（extended spectrum β-lactamases , ESBLs）的产生。对细菌产ESBLs情况进行监测，