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目的了解本地区ICU分离的产ESBLs大肠埃希菌和肺炎克雷伯菌的分布及对常用抗菌药物的耐药性,为临床抗菌药物的合理使用提供依据。方法采用K-B纸片扩散法,检测2013年-2015年ICU感染类标本分离的无重复的778株大肠埃希菌和570株肺炎克雷伯菌的耐药情况,并对结果进行统计分析。结果 2013年-2015临床标本中产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为52.96%和44.74%,ICU产ESBLs大肠埃希菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率为0.00%~30.34%。产ESBLs肺炎克雷伯菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率为0.00%~23.53%。ICU产ESBLs菌株耐药率明显高于非产ESBLs菌株,差异有统计学意义(P<0.05)。结论 ICU产ESBLs大肠埃希菌与肺炎克雷伯菌对各类抗菌药物呈现不同程度耐药,并具多药耐药特点,碳青霉烯类仍是最敏感的药物;应加强产ESBLs菌株的监测及耐药性分析,以指导临床合理应用抗菌药物,对控制产ESBLs菌株的播散以及耐药基因的传播具有重要意义。
Objective To understand the distribution of ESBLs-producing Escherichia coli and Klebsiella pneumoniae isolates isolated from ICU in this area and their resistance to commonly used antimicrobial agents, so as to provide basis for the rational use of clinical antimicrobial agents. Methods The drug resistance of 778 Escherichia coli and 570 Klebsiella pneumoniae isolates isolated from ICU-infected specimens from 2013 to 2015 were detected by K-B disc diffusion method. The results were statistically analyzed. Results The detection rates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae in clinical specimens from 2013 to 2015 were 52.96% and 44.74%, respectively. The detection rates of ESBLs-producing Escherichia coli in ICU against Meropenem, Imipenem, Star, piperacillin / tazobactam, cefoperazone / sulbactam resistance rate of 0.00% to 30.34%. The resistance rates of producing ESBLs Klebsiella pneumoniae to meropenem, imipenem, amikacin, piperacillin / tazobactam and cefoperazone / sulbactam ranged from 0.00% to 23.53%. The drug-resistant rates of ESBLs-producing strains in ICU were significantly higher than those in non-ESBLs-producing strains, the difference was statistically significant (P <0.05). Conclusion ESBLs-producing ESBLs-producing Escherichia coli and Klebsiella pneumoniae showed different degrees of resistance to various antimicrobial agents and were characterized by multi-drug resistance. Carbapenems were still the most sensitive drugs. ESBLs producing strains should be strengthened Monitoring and drug resistance analysis to guide clinical rational use of antimicrobial agents, to control spread of ESBLs producing strains and the spread of drug resistance genes is of great significance.