Bishara Jihad, Livne Gilat, Ashkenazi Shai, Levy Itzhak, Pitlik Silvio, Ofir Orit, Lev Bruria, Samra Zmira
Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel.
Isr Med Assoc J. 2005 May;7(5):298-301.
The prevalence of extended-spectrum beta-lactamase-producing organisms and their antimicrobial resistance patterns may vary between geographic areas.
To evaluate the prevalence and susceptibility of ESBL-producing organisms among Klebsiella pneumoniae and Escherichia coli isolated from adult and pediatric patients in two Israeli hospitals.
ESBL production was tested according to recommendations of the Clinical and Laboratory Standards Institute, using ceftazidime (30 microg) and a combination of ceftazidime/clavulanate (30/ 10 microg) disks with a > or =5 mm difference indicating positivity. Antibiotic susceptibilities were determined by the disk diffusion method according to CLSI standards. Minimal inhibitory concentrations were determined by the E-test.
The prevalence of ESBL-producing organisms was significantly higher among K. pneumoniae than E. coli isolates - 32% (241/765) vs. 10% (57/547) respectively (P < 0.001), and more frequently isolated from adults than children (odds ratio 2.27 for K. pneumoniae and 12.94 for E. coli). Resistance rates for amoxicillin/ clavulanate, piperacillin-tazobactam, amikacin, and ciprofloxacin among the ESBL-producing K. pneumoniae and E. coli isolates were 95%, 82%, 49% and 77% for K. pneumoniae, and 77%, 35%, 25% and 100% for E coli. Two (0.8%) ESBL-producing and 4 (0.7%) ESBL-negative K. pneumoniae isolates showed intermediate susceptibility (MIC 6 microg/ml) to meropenem. All isolates were sensitive to ertapenem and colistin.
ESBL production among K. pneumoniae and E. coli is more prevalent in the adult population than the pediatric population and is associated with multidrug resistance.
产超广谱β-内酰胺酶微生物的流行情况及其抗菌耐药模式可能因地理区域而异。
评估以色列两家医院从成年和儿科患者中分离出的肺炎克雷伯菌和大肠杆菌中产ESBL微生物的流行情况和药敏性。
根据临床和实验室标准协会的建议检测ESBL的产生，使用头孢他啶（30微克）和头孢他啶/克拉维酸（30/10微克）组合药敏纸片，抑菌圈直径差异≥5毫米为阳性。根据CLSI标准通过纸片扩散法测定抗生素敏感性。通过E试验测定最低抑菌浓度。
肺炎克雷伯菌中产ESBL微生物的流行率显著高于大肠杆菌分离株，分别为32%（241/765）和10%（57/547）（P<0.001），且在成人中比儿童中更常分离到（肺炎克雷伯菌的优势比为2.27，大肠杆菌为12.94）。肺炎克雷伯菌和大肠杆菌产ESBL分离株中，阿莫西林/克拉维酸、哌拉西林-他唑巴坦、阿米卡星和环丙沙星的耐药率，肺炎克雷伯菌分别为95%、82%、49%和77%，大肠杆菌分别为77%、35%、25%和100%。两株（0.8%）产ESBL和4株（0.7%）ESBL阴性的肺炎克雷伯菌分离株对美罗培南表现为中介敏感性（MIC为6微克/毫升）。所有分离株对厄他培南和黏菌素敏感。
肺炎克雷伯菌和大肠杆菌中产ESBL在成人中比儿科人群中更普遍，且与多重耐药相关。
