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目的探讨产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌的流行趋势及耐药谱分析,为肺炎克雷伯菌感染防控提供抗生素使用的合理依据。方法采用法国生物梅里埃公司VITEK-2全自动细菌鉴定仪对2011-2013年广州医科大学附属第二医院住院患者各类标本进行分离鉴定,参照美国临床实验室标准化委员会(CLSI)推荐方法确认产ESBLs菌株,采用纸片扩散法(K-B)对检出的产ESBLs肺炎克雷伯菌的药敏结果进行分析。结果检出肺炎克雷伯菌486株,痰液的检出率最高占86.4%,感染人群以老年群体为主,超过60岁检出率为60.5%。产ESBLs菌株248株,总检出率为51.0%,对抗生素耐药率较高的依次为氨苄西林、头孢噻肟、庆大霉素、复方新诺明和氨曲南;亚胺培南的敏感性最高。结论肺炎克雷伯菌引起的感染以呼吸道为主,易感人群为老年人,产ESBLs的发生率较高,对三代头孢耐药严重,可优先考虑选用亚胺培南。
Objective To investigate the epidemic trend and spectrum analysis of Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) and to provide a reasonable basis for antibiotic use in the prevention and control of Klebsiella pneumoniae infection. Methods The specimens of inpatients in the Second Affiliated Hospital of Guangzhou Medical University from 2011 to 2013 were isolated and identified by the VITEK-2 automatic bacterial analyzer from French Bioserieux. According to the recommended method of CLSI (American Society for Clinical Laboratory Standardization) ESBLs strains, using disk diffusion (KB) detected ESBLs-producing Klebsiella pneumoniae drug susceptibility results were analyzed. Results A total of 486 strains of Klebsiella pneumoniae were detected. The highest detection rate of sputum was 86.4%. The infected population was mainly elderly population. The detection rate was 60.5% over 60 years old. 248 strains of ESBLs producing strains, the total detection rate was 51.0%, the antibiotic resistance rates were followed by ampicillin, cefotaxime, gentamicin, cotrimoxazole and aztreonam; imipenem sensitivity The highest sex. Conclusions The infection caused by Klebsiella pneumoniae is mainly respiratory tract, the susceptible population is elderly, the incidence of producing ESBLs is high, the resistance to third generation cephalosporins is serious, and imipenem may be the priority choice.