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目的对产超广谱β-内酰胺酶(ESBLs)的病原菌分布及耐药性进行分析,进而为临床合理用药提供依据。方法应用西门子MicroScan autoSCAN4全自动细菌鉴定及药敏分析仪对2014年1月-12月在大连市妇幼保健院住院患者送检的标本进行菌株鉴定及药敏分析,对提示产ESBLs的大肠埃希菌和肺炎克雷伯菌进行纸片扩散法确认,统计分析其分布情况及耐药情况。采用ERIC-PCR法检测同源性。结果检测出125株产ESBLs的肠杆菌,包括大肠埃希菌88株,肺炎克雷伯菌37株。其病区分布情况:肺炎克雷伯菌主要分布在新生儿科,占67.6%,且存在流行感染。大肠埃希菌主要分布在各个产科病房,占48.9%。产ESBLs的肠杆菌对18种抗菌药物的分析表明对β-内酰胺类及第三代头孢菌素类抗生素耐药率达100.0%,对氨基糖苷类、喹诺酮类、四环素类和磺胺类药物出现不同程度的耐药,对碳青霉烯类抗生素敏感率较高。结论临床分离的产ESBLs的肠杆菌主要以大肠埃希菌和肺炎克雷伯菌为主,且为多重耐药,甚至广泛耐药,因此临床治疗上应严格合理选用抗生素。
Objective To analyze the distribution and drug resistance of pathogenic bacteria producing extended-spectrum β-lactamases (ESBLs), and to provide basis for clinical rational drug use. Methods Strain identification and drug susceptibility analysis of hospitalized patients in Maternal and Child Health Hospital of Dalian from January 2014 to December 2014 were carried out with Siemens MicroScan autoSCAN4 automatic bacterial identification and drug sensitivity analyzer. The results of ESBLs-producing Escherichia coli Bacteria and Klebsiella pneumoniae were confirmed by disk diffusion method, statistical analysis of their distribution and drug resistance. Homology was detected by ERIC-PCR. Results A total of 125 enterobacteria producing ESBLs were detected, including 88 strains of Escherichia coli and 37 strains of Klebsiella pneumoniae. The ward distribution: Klebsiella pneumoniae mainly in neonatology, accounting for 67.6%, and the prevalence of infection. Escherichia coli is mainly distributed in various maternity wards, accounting for 48.9%. The analysis of 18 kinds of antibacterials by ESBLs-producing Enterobacteriaceae showed that the resistance rates of β-lactams and third-generation cephalosporins reached 100.0%, and the occurrence of aminoglycosides, quinolones, tetracyclines and sulfonamides Different degrees of resistance, high sensitivity to carbapenem antibiotics. Conclusions The clinically isolated Enterobacteriaceae producing ESBLs are mainly Escherichia coli and Klebsiella pneumoniae, and are multi-drug resistant and even multi-drug resistant. Therefore, antibiotics should be strictly and rationally selected for clinical treatment.