ESBL阳性的肺炎克雷伯菌和大肠埃希菌对常用抗生素的耐药性研究

发布时间：2018-01-08 12:21

本文关键词：ESBL阳性的肺炎克雷伯菌和大肠埃希菌对常用抗生素的耐药性研究　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：检测淄川地区超广谱β-内酰胺酶(extended spectrum beta lactamase, ESBL)阳性的肺炎克雷伯菌和ESBL阳性的大肠埃希菌对常用抗生素的耐药情况,研究在该地区常用抗生素对这两类细菌的应用前景。方法：收集淄川地区医院自2013年8月至2014年10月分离到的511株肺炎克雷伯菌和403株大肠埃希菌。采用临床和实验室标准化研究所(CLSI)推荐的ESBL表型确证试验方法检测ESBL,用肉汤微量稀释法检测常用抗生素的最小抑菌浓度(minimum inhibition concentration, MIC)值。判断药敏结果采用CLSI(Clinical and Laboratory Standards Institute)2012年M100-S22标准。运用Whonet软件对检测资料进行统计,并用X2检验对ESBL日性的肺炎克雷伯菌和ESBL阴性的肺炎克雷伯菌以及ESBL阳性的大肠埃希氏菌和ESBL阴性的大肠埃希氏菌对常用抗生素的耐药率进行统计学分析。结果：肺炎克雷伯菌共有511株,ESBL阳性的肺炎克雷伯菌有151株,阳性率为29.55%,对常用抗生素的耐药率依次为头孢曲松96.69%、阿莫西林／克拉维酸32.45%、头孢西丁17.88%、环丙沙星31.79%、头孢吡肟17.22%、头孢唑林100.00%、庆大霉素64.24%、亚胺培南0%,ESBL阴性的肺炎克雷伯菌有360株,对常用抗生素的耐药率依次为头孢曲松7.78%、阿莫西林／克拉维酸9.44%、头孢西丁10.00%、环丙沙星8.61%、头孢吡肟3.33%、头孢唑林13.61%、庆大霉素6.39%、亚胺培南0%。大肠埃希氏菌共有403,ESBL阳性的大肠埃希菌262株,阳性率为65.01%,对常用抗生素的耐药率依次为头孢曲松99.24%、环丙沙星87.79%、头孢吡肟50.76%、头孢西丁38.55%、阿莫西林／克拉维酸27.48%、头孢唑林100.00%、庆大霉素56.49%、亚胺培南0%,ESBL阴性的大肠埃希氏菌有141株,对常用抗生素的耐药率依次为头孢曲松12.06%、环丙沙星45.39%、头孢吡肟2.13%、头孢西丁15.60%、阿莫西林／克拉维酸18.44%、头孢唑林21.99%、庆大霉素39.01%、亚胺培南0%。除亚胺培南外,其他抗生素经过统计学X2检验分析得出：ESBL阳性的肺炎克雷伯菌对常用抗生素耐药率明显高于ESBL阴性的肺炎克雷伯菌对常用抗生素耐药率,ESBL阳性的大肠埃希菌对常用抗生素耐药率明显高于ESBL阴性的大肠埃希菌对常用抗生素耐药率。即P均小于0.05都存在显著性差异,有统计学意义。结论：本地区超广谱β-内酰胺酶阳性的肺炎克雷伯氏菌和超广谱β-内酰胺酶阳性的大肠埃希氏菌对常用抗生素的耐药率高于超广谱β-内酰胺酶阴性的肺炎克雷伯氏菌和超广谱β-内酰胺酶阴性的大肠埃希氏菌对常用抗生素的耐药率,且耐药率较高,因此对ESBL阳性的菌株临床应当参照药敏试验结果合理使用抗生素。
[Abstract]:Objective: to detect extended spectrum beta lactamase of extended-spectrum 尾 -lactamases in Zichuan area. Resistance of Klebsiella pneumoniae and ESBL positive Escherichia coli to common antibiotics. To study the application prospect of antibiotics to these two kinds of bacteria in this area. Methods:. To collect 511 strains of Klebsiella pneumoniae and 403 strains of Escherichia coli isolated from August 2013 to October 2014 in Zichuan District Hospital. The ESBL phenotypic confirmatory test method recommended by CLSI was used to detect ESBL. The minimal inhibitory concentration (inhibition concentration) of commonly used antibiotics was determined by broth microdilution method. CLSI(Clinical and Laboratory Standards Institute was used to judge the drug sensitivity. In 2012, M100-S22 standard. Whonet software was used to statistics the data. The results of X2 test were used to detect the antibiotics of Klebsiella pneumoniae, Klebsiella pneumoniae, ESBL negative Klebsiella pneumoniae and ESBL positive Escherichia coli and ESBL negative Escherichia coli. Results:. There were 511 strains of Klebsiella pneumoniae. There were 151 strains of Klebsiella pneumoniae positive for ESBL, and the positive rate was 29.555.The drug resistance rate to commonly used antibiotics was ceftriaxone 96.699.69 and amoxicillin / clavulanic acid 32.45%. Cefoxitin 17.88, ciprofloxacin 31.79, cefepime 17.22, cefazolin 100.00000, gentamicin 64.24, imipenem 0%. There were 360 strains of Klebsiella pneumoniae negative for ESBL. The drug resistance rate to common antibiotics was ceftriaxone 7.78, amoxicillin / clavulanic acid 9.44 and cefoxitin 10.00%. Ciprofloxacin 8.61, cefepime 3.33, cefazolin 13.61, gentamicin 6.39, imipenem 0. Escherichia coli 403. There were 262 strains of Escherichia coli positive for ESBL, the positive rate was 65.01. The drug resistance rate to common antibiotics was ceftriaxone 99.2424, ciprofloxacin 87.79%. Cefepime 50.76, cefoxitin 38.55, amoxicillin / clavulanic acid 27.48, cefazolin 100.00m, gentamicin 56.49 and imipenem 0%. There were 141 strains of Escherichia coli negative for ESBL. The resistance rates to common antibiotics were ceftriaxone 12.06, ciprofloxacin 45.39and cefepime 2.13%. Cefxitin 15.60, amoxicillin / clavulanic acid 18.44, cefazolin 21.99, gentamicin 39.01, imipenem 0. Except imipenem. The results of X2 analysis showed that the resistance rate of Klebsiella pneumoniae positive to common antibiotics was significantly higher than that of ESBL negative Klebsiella pneumoniae. The resistance rate of ESBL positive Escherichia coli to common antibiotics was significantly higher than that of ESBL negative Escherichia coli to common antibiotics (P < 0. 05). Statistically significant. Conclusion:. Extended-spectrum 尾 -lactamase positive Klebsiella pneumoniae and extended-spectrum 尾 -lactamase positive Escherichia coli were more resistant to common antibiotics than extended-spectrum 尾 -lactamase negative pneumonia Klebsiella pneumoniae. Resistance rate of Escherichia coli and extended-spectrum 尾 -lactamase negative Escherichia coli to common antibiotics. The rate of drug resistance was high, so antibiotics should be used reasonably according to the results of drug sensitivity test for ESBL positive strains.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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