【摘要】 目的　观察清远地区产超广谱β-内酰胺酶 ( ESBL s)克雷伯菌的耐药性和流行情况 ,指导临床用药。方法　应用 Micro Scan Auto SCAN- 4专用 NC2 1鉴定板检测 1 0 7例克雷伯菌的 ESBL s产生和研究其对体外抗生素的耐药性。结果　克雷伯菌属中产 ESBLs的肺炎克雷伯菌、产酸克雷伯菌、解鸟氨酸克雷伯菌、臭鼻克雷伯菌、鼻硬结克雷伯菌阳性率分别为 6 0 .1 %、33.3%、50 .0 %、50 .0 %、50 .0 % ,以重症监护病房 ( 91 .6 % )最高 ,颅脑外科病房 ( 88.2 % )次之。产ESBL s克雷伯菌对头孢菌素类、青霉素类、氨基糖甙类、环丙沙星、复方新诺明等抗生素呈现多重耐药 ,耐药率 56 .0 %～94.9%。而非产 ESBL s克雷伯菌对头孢菌素类、氨基糖甙类、环丙沙星耐药率低 ,为 2 .1 %～ 2 7.1 %。两者之间差异有显著意义 ( P<0 .0 1 ) ;对亚胺培南、哌拉西林 /三唑巴坦的高敏感性分别为 96 .6 %与 79.6 %。结论　清远地区具有较高的产ESBL s克雷伯菌流行率 ,对于产 ESBL s克雷伯菌应以亚胺培南、哌拉西林 /三唑巴坦为首选药物。一旦发现产 ESBL s细菌局部流行时应立即停用头孢菌素和氨曲南等抗生素。更多还原

【Abstract】 Objective To observe the drug resistance and the prevalence of Klebsiella strains producing Extended Spectrum βlactamases(ESBLs) in Qingyuan area of GuangDong province, for instructing the clinic practice.Methods ESBLs produced by 107 strains of Klebsiella NC was detected with 21 board of MicroScan AutoSCAN 4 and the in vitro antibiotic resistance was studied.Results The positive rate of producing ESBLs of Klebsiella pneumonia, Klebsiella oxytoca, Klebsiella ornithinolyt, Klebsiella ozaenae, Klebsiella rhinoscleromatis was 60.1%,33.3%,50.0%,50.0%,50.0% correspondly. The positive rate in ICU was the highest, the second was in department of brain surgery. The resistance rate of Klebsiella strains producing ESBLs to cephalosporins,penicillins,aminoglucosides,ciprofloxacin,trimethoprim/sultamethoxazole was multiple, which was 56.0%～94.9%?But resistance rate of Klebasiclla strains without producing ESBLs to cephalosporins, aminoglucosides, ciprofloxacin was low, 2.1%～27.1%?There was significance difference(P<0.01) between two groups. The sensitive to imipenem and piperacillin/tazobac is 96.6% and 79.6% respectively.Conclusions There is high prevalence of Klebsiclla strains producing ESBLs in Qingyuan area. Imipenem and piperacillin/tazobac is the first used drug to kill the Klebsiella strains producing ESBLs. Stopping to use cephalosporins and aztreonam as soon as finding the partial prevalence of Klebsiella strains producing ESBLs, which is a fundamental principle.更多还原