呼吸道感染超广谱β-内酰胺酶细菌检测及药敏分析

产超广谱β—内酰胺酶肺炎克雷伯菌的检测及耐药性分析目的调查中国医科大学附属盛京医院（以下简称“我院”）住院患者产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌的临床分布及耐药性，为临床医师抗感染治疗提供依据。

方法收集2015年1～12月我院住院患者送检的各类标本，采用VITEK 2 Compact进行细菌鉴定和药敏试验，按照CLSI推荐的方法进行ESBLs初步筛选和表型确证试验，并对阳性患者耐药性进行分析。

结果共检出产ESBLs肺炎克雷伯菌302株，其中痰液标本中检出最多，占38.74%，其次是全血和尿液，分别占28.81%和13.91%；科室分布以儿科和普通外科为主，分别占53.97%和7.95%。

产ESBLs肺炎克雷伯菌对氨苄西林、头孢唑啉、哌拉西林、头孢曲松、头孢噻肟的耐药率均在95%以上，而对碳青霉烯类药物的耐药率较低，低于3%。

结论住院患者产ESBLs肺炎克雷伯菌的耐药率高，治疗难度大，医师应根据药敏试验结果加强对抗生素的合理使用。

[Abstract] Objective To analyze the clinical distribution and drug resistance of extended-spectrum beta-lactamase （ESBLs）-producing Klebsiella pneumoniae in hospitalized patients in Shengjing Hospital Affiliated to China Medical University （”our hospital” for short），in order to provide references for therapy of infections. Methods ESBLs-producing Klebsiella pneumoniae isolated in our hospital from January to December 2015 were collected. The bacteria identification and drug sensitivity test were performed by the VITEK 2 Compact. The ESBLs preliminary screening and the phenotypic confirmatory test were taken according to the guideline of CLSI，and at the same time，the results of the drug sensitivity test were analyzed. Results 302 strains of ESBLs-producing Klebsiella pneumoniae were isolated，which were mostly isolated from sputum samples （38.74%），followed by blood （28.81%）and urine （13.91%）. The bacteria were mainly distributed in Paediatrics Department （53.97%）and General Surgery Department （7.95%）. The drug resistances of ESBLs-producing Klebsiella pneumoniae to Ampicillin，Cefazolin，Piperacillin，Ceftriaxone，Cefotaxime in hospitalized patients were more than 95%，and the resistance rate to carbapenemes was lower，less than 3%. Conclusion The isolated ESBLs-producing Klebsiella pneumoniae in hospitalized patients are highly resistant to the commonly used antibiotics，and the treatment is difficult. Therefore，the drug sensitive test should be strengthened to direct clinical rational use of antibiotics.[Key words] Klebsiella pneumoniae；Extended spectrum beta-lactamases；Drug resistance；Pathogens肺炎克雷伯菌廣泛分布于自然界，是引起呼吸道感染重要的條件致病菌，其临床分离率在革兰阴性杆菌中居第3位[1-2]。

超广谱β-内酰胺酶的检测及耐药性分析莫志航;宁炎【摘要】目的了解临床产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(E.coli)和肺炎克雷伯菌(K.pneumoniae)的发生率、耐药性,以便于对ESBLs进行监测和治疗.方法对102株E.coli和78株K.pneumoniae采用美国临床实验室标准委员会(NCCLS)规定的ESBLs表型筛选和确证试验确定ESBLs的发生率,并检测产ESBLs的E.coli 和K.pneumoniae的耐药性.结果 13.7％ (14/102)的大肠埃希菌和26.9％ (21/78)的肺炎克雷伯菌产ESBLs;产ESBLs菌株对亚胺培南耐药率为0％,除对阿米卡星、头孢西丁、替卡西林/克拉维酸联合酶抑制剂耐药率较低外,对三代头孢菌素、磺胺类和喹诺酮类药物均出现较高耐药.结论对产ESBLs菌株引起的感染,亚胺培南为首选.%Objective To investigate the prevalence of strains producing extended spectrum beta-lactamases (ESBLs) among Escherichia coil and Klebsiella pneumoniae, and to determine the drug resistance of the strans for better control and treatment of ESBLs. Methods One hundred and two strains of E. coli and 78 strains of K. pneumoniae were investigated for production of ESBLs by phenotypic screening and confirmatory test provided by the NCCLS. The drug resistance of ESBLs-producing strains was also investigated. Results 13.7% (14/102) of E. coli and 26.9% (21/78) of K. pneumoniae investigated were found to produce ESBLs. All ESBLs-producing strains were found to be susceptible to imipenem, relatively lowly resistant to of amikacin, cefoxitin, cefoperazone/β-lactamase inhibitor com-binations, and highly resistant to third generation cephalosporins, sulfonamides and quinolones. Conclusion Imipen-em isthe premium antibiotics for the treatment.of infection caused by ESBLs-producing strains.【期刊名称】《海南医学》【年(卷),期】2012(023)018【总页数】2页(P78-79)【关键词】超广谱β-内酰胺酶;大肠埃希菌;肺炎克雷伯菌;耐药性【作者】莫志航;宁炎【作者单位】增城市新塘医院检验科,广东增城511340;增城市新塘医院检验科,广东增城511340【正文语种】中文【中图分类】R446超广谱β-内酰胺酶(ESBLs)主要由大肠埃希菌和肺炎克雷伯菌产生，能水解青霉素类、头孢菌素类和单酰胺类抗生素，从而使之失效[1]。

呼吸道感染超广谱β－内酰胺酶细菌检测及药敏分析目的：了解呼吸道感染革兰氏阴性菌产ESBLs发生率及耐药情况，指导临床合理用药。

方法：采用双纸片协同试验法及复合纸片确证法对临床呼吸道标本分离的248株革兰氏阴性菌进行ESBLs检测。

结果：产ESBLs菌占全部呼吸道标本革兰氏阴性菌的19.8％。

产ESBLs菌对15种常用抗菌药物的耐药率明显高于非产ESBLs菌株。

结论：常规检测ESBLs对指导临床合理选用抗菌药物有重要意义。

标签：革兰氏阴性杆菌；超广谱β－内酰胺酶；耐药性β－内酰胺类抗生素是临床上应用最广泛的抗菌药物，近年来产超广谱β－内酰胺酶(ESBLs)的菌株愈来愈多。

产ESBLs菌株不仅对三代头孢菌素有较高耐药率，而且对喹诺酮类、氨基糖甙类和磺胺类等临床常用抗生素均有不同程度耐药，给临床治疗带来困难。

呼吸道感染是临床常见病、多发病，为了解呼吸道标本革兰氏阴性菌产ESBLs的发生率、分布及耐药特点，现对本院2004～2006年呼吸道标本革兰氏阴性菌产ES-BLs的情况及耐药性进行分析，报告如下。

1材料与方法1.1材料1.1.1 菌株来源本院2004～2006年住院及门诊患者呼吸道标本培养分离的248株革兰氏阴性菌。

质控菌株为大肠埃希菌ATCC25922(ESBLs阴性)，肺炎克雷伯菌ATCC700603(ESBLs阳性)。

1.1.2药敏纸片M-H琼脂，头孢他啶(CAZ)30μg／片，头孢曲松(CRO)30μg ／片，头孢噻肟(CTX)30μg／片，氨曲南(ATM)30μg／片，阿莫西林／克拉维酸(AMC)(20／μg／10μg)，头孢他啶／克拉维酸(30μg／10μg)，头孢噻肟／克拉维酸(30μg／10μg)等15种抗生素纸片购自杭州天和微生物有限公司。

1.2方法1.2.1 药敏试验采用K－B法，按2003年美国临床实验室标准化委员会(NCCLS)标准判断结果。

1.2.2产ESBLs菌检测选用CAZ(30μg／片)、ATM(30／μg／片)、CRO(30μg ／片)、CTX(30μg／片)。