[从一家私立医院尿路感染患者中分离出的产超广谱β-内酰胺酶大肠埃希菌和克雷伯菌属菌株的抗生素耐药率]

[Antibiotic resistance rates of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections in a private hospital].

作者信息

Akyar Işin

出版信息

Mikrobiyol Bul. 2008 Oct;42(4):713-5.

PMID:19149097

Abstract

The aim of this study was to detect the antibiotic resistance rates of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections (UTIs) in Private Acibadem Hospital, Istanbul, Turkey. A total of 1100 E. coli and 356 Klebsiella spp. strains isolated from 17.028 urine cultures which were processed between October 2006 and August 2007 in the clinical laboratory, were included to the study. Identification of bacteria and antibiotic susceptibility tests were performed by Phoenix (Becton Dickinson, USA) automated system. Of E. coli strains 12% (n= 132) were found positive for ESBL, while this rate was 12% (n= 41) for Klebsiella spp. strains (38 K.pneumoniae, 3 K. oxytoca). The resistance rates of ESBL producing E. coli and Klebsiello spp. strains were found as follows respectively; 3% and 2.4% for amikacin, 3% and 85.4% for nitrofurantoin, 0% and 4.9% for fosfomycin, 5.3% and 100% for cefoxitin, 21.2% and 58.5% for piperacilin/tazobactam, 34.8% and 41.5% for gentamicin, 68.9% and 58% for trimethoprim/sulfamethoxazole (TMP-SMX), 75.9% and 56.1% for tobramycin, 80.3% and 21.9% for ciprofloxacin and norfloxacin. All of the ESBL positive E. coli and Klebsiella spp. strains were resistant to ampicilin, aztreonam, cefazolin, cefepime, ceftazidime, ceftriaxone and cefuroxime-sodium; while all of the ESBL positive E. coli and Klebsiella spp. strains were sensitive to imipenem and meropenem. The rates of resistance obtained in this study were higher than the rates obtained in other studies performed in our country. This could be attributed to the different antibiotic use policies of different centers or to more frequent use of antibiotics by the patients applied to private hospitals, owing to their higher socioeconomical status and easier attainment of antibiotics without prescription.

摘要

本研究旨在检测从土耳其伊斯坦布尔阿西巴德姆私立医院尿路感染（UTIs）患者中分离出的产超广谱β-内酰胺酶（ESBL）的大肠杆菌和克雷伯菌属菌株的抗生素耐药率。该研究纳入了2006年10月至2007年8月间临床实验室处理的17028份尿培养物中分离出的总共1100株大肠杆菌和356株克雷伯菌属菌株。细菌鉴定和抗生素敏感性试验通过美国贝克曼库尔特公司的Phoenix自动化系统进行。在大肠杆菌菌株中，12%（n = 132）被发现ESBL检测呈阳性，而克雷伯菌属菌株的这一比例为12%（n = 41）（38株肺炎克雷伯菌，3株产酸克雷伯菌）。产ESBL的大肠杆菌和克雷伯菌属菌株的耐药率分别如下：阿米卡星为3%和2.4%，呋喃妥因为3%和85.4%，磷霉素为0%和4.9%，头孢西丁为5.3%和100%，哌拉西林/他唑巴坦为21.2%和58.5%，庆大霉素为34.8%和41.5%，甲氧苄啶/磺胺甲恶唑（TMP-SMX）为68.9%和58%，妥布霉素为75.9%和56.1%，环丙沙星和诺氟沙星为80.3%和21.9%。所有ESBL阳性的大肠杆菌和克雷伯菌属菌株对氨苄西林、氨曲南、头孢唑林、头孢吡肟、头孢他啶、头孢曲松和头孢呋辛钠均耐药；而所有ESBL阳性的大肠杆菌和克雷伯菌属菌株对亚胺培南和美罗培南均敏感。本研究中获得的耐药率高于我国其他研究中的耐药率。这可能归因于不同中心不同的抗生素使用政策，或者归因于私立医院患者因其较高的社会经济地位且无需处方更容易获得抗生素，从而更频繁地使用抗生素。