摘要
目的比较不同等级医院产超广谱β-内酰胺酶（ESBLs）细菌检出率及耐药性特点,指导合理选用抗生素。方法对2007-01-2007-10重庆市中山医院（三级）和重庆云阳县人民医院（二级）感染患者中分别检出的206株和120株革兰阴性病原菌按照美国临床和实验室标准化协会（CLSI/NCCLS）标准进行鉴定、产ESBLs检测和药敏试验,χ^2检验分析其构成比、产ESBLs菌检出率、耐药性差异。结果不同级别医院检出革兰阴性病原菌构成比无差异,以大肠埃希菌为主。产ESBLs菌检出率三级医院高于二级医院（P〈0.05）,三级医院住院患者高于门诊（P〈0.05）及二级医院住院患者（P〈0.05）;二级医院ICU检出率高于同院内、外科（P〈0.05）,与三级医院ICU比较无统计学差异（P〉0.05）。二级医院非产ESBLs菌对头孢类抗生素耐药性低于三级医院（P〈0.05）;不同级别医院产ESBLs菌均对第三代头孢菌素药物产生明显的耐药性（P〉0.05）,而对亚胺培南高度敏感。二级医院产ESBLs大肠埃希菌株对头孢西丁、头孢美唑、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦四种药物的耐药性低于三级医院,差异有统计学意义（P〈0.05）。结论不同等级医院患者来源、抗生素消耗情况不同,产ESBLs菌株检出率及耐药性各有特点,制定相应病原菌谱及耐药谱对合理应用抗生素意义重大。
Objective To compare the difference of distribution and drug resistance of extended-spectrum beta-lactamases（ESBLs）-producing pathogens between Chongqing Zhongshan Hospital（a tertiary care hospital,TCH）and Chongqing Yunyang People＇s Hospital（a second grade care hospital,SCH）.Methods A total of 206 and 120 strains of gram-negative bacilli were isolated from the patients with infectious diseases from January to October 2007 in TCH and SCH,respectively.The bacilli were identified,and given ESBLs detection and antibacterial drug sensitivity test in accordance with the process of CLSI/NCCLS（Clinical and Laboratory Standards Institute）.Chi-square test was used for statistical analysis. Results The constituent ratio of pathogens had no significant difference between TCH and SCH,and Escherichia coli was the most predominant pathogen.The isolation rate of ESBLs-producing bacilli in TCH was higher than that in SCH（χ2=6.18,P〈0.05）,and that from in-patient department in TCH was higher than that from out-patient department（χ^2=4.49,P〈0.05）or that from in-patient department in SCH（χ^2=6.56,P〈0.05）.The isolation rate of ESBLs-producing bacilli from ICU in SCH was significantly higher than that from medical department or surgery department（P〈0.05,respectively）,but compared to that from ICU in TCH,there was no significant difference（χ^2=0.002,P〉0.05）.The resistance rate of ESBLs（-）bacilli to cephalosporin in SCH was lower than that in TCH.All ESBLs（＋）bacilli from two hospitals were insensitive to cefotaxime,ceftriaxone or ceftazidime,but highly sensitive to imipenam.The resistance rates of ESBLs（＋）bacilli to cefoxitin,cefmetazole,piperacillin/tazobactam,cefoperazone/sulbactam in SCH were significantly lower than that in TCH,respectively. Conclusion Patients and the consumption of antibiotics are hospital-specific in different grade care hospitals.The isolation rate of ESBLs-producing bacilli and the resistance rate of bacilli to antibiotics are also hospital-specific.To formulate a specific pathogen and drug resistance table in accordance with the identification and antibacterial drug sensitivity test of pathogens is important for reasonable use of antibiotics.
出处
《山西医科大学学报》
CAS
2008年第5期449-453,共5页
Journal of Shanxi Medical University
关键词
病原菌
耐药性
超广谱Β-内酰胺酶
pathogen
drug resistance
extended-spectrum beta-lactamases
作者简介
朱金梅，女，1974—12生，本科，主管技师．
