Işik Ferhat, Arslan Uğur, Tuncer Inci
Selçuk Universitesi Meram Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Konya.
Mikrobiyol Bul. 2008 Jan;42(1):131-6.
This study was carried out to detect the extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae strains isolated from blood cultures of hospitalized patients, and to determine their antimicrobial susceptibilities. A total of 102 K. pneumoniae strains isolated from blood samples were taken in the study, and ESBL production and susceptibilities to amikacin, gentamicin, imipenem, ciprofloxacin, amoxicillin/clavulonate (AMX/CA), ceftazidime, ceftriaxone, trimethoprim/ sulphametoxazole (TMP-SMX), piperacilin-tazobactam (PIP/TAZ) and chloramphenicol were investigated by using E-test (AB Biodisk, Sweden). ESBL positivity was observed in 65 (63.7%) of the isolates, and all of the strains were found susceptible to imipenem. The resistance rates of ESBL-producing isolates were detected as 27.7% for amikacin, 41.5% for chloramphenicol, 49.2% for TMP-SMX, 55.4% for ciprofloxacin and 60% for PIP/TAZ; whereas these rates for ESBL non-producers were 2.7%, 5.4%, 5.4%, 2.7%, and 13.5%, respectively. Both the resistance rates and MIC values (MIC50 and MIC90) of the tested antimicrobial agents except imipenem, were found higher in ESBL positive strains than the ESBL negative strains (p < 0.05). The results of this study, in accordance with the previous national and international reports, indicated high rate of ESBL positive K. pneumoniae and also increased rate of antimicrobial resistance in such strains. Clinical microbiology laboratories should put ESBL detection tests into practice and each hospital should determine their antibiotic treatment policies according to their data.
本研究旨在检测从住院患者血培养物中分离出的产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌菌株,并确定其抗菌药敏性。本研究共采集了102株从血样中分离出的肺炎克雷伯菌菌株,采用E-test(瑞典AB Biodisk公司)检测ESBL的产生情况以及对阿米卡星、庆大霉素、亚胺培南、环丙沙星、阿莫西林/克拉维酸(AMX/CA)、头孢他啶、头孢曲松、甲氧苄啶/磺胺甲恶唑(TMP-SMX)、哌拉西林-他唑巴坦(PIP/TAZ)和氯霉素的药敏性。在65株(63.7%)分离株中观察到ESBL阳性,所有菌株均对亚胺培南敏感。产ESBL分离株对阿米卡星的耐药率为27.7%,对氯霉素为41.5%,对TMP-SMX为49.2%,对环丙沙星为55.4%,对PIP/TAZ为60%;而ESBL非产生株的这些耐药率分别为2.7%、5.4%、5.4%、2.7%和13.5%。除亚胺培南外,受试抗菌药物的耐药率和MIC值(MIC50和MIC90)在ESBL阳性菌株中均高于ESBL阴性菌株(p<0.05)。本研究结果与之前的国内和国际报告一致,表明产ESBL肺炎克雷伯菌的比例较高,且此类菌株的抗菌耐药率也有所上升。临床微生物实验室应开展ESBL检测试验,各医院应根据自身数据确定抗生素治疗策略。