Paluchowska Paulina, Skałkowska Małgorzata, Spelak Anna, Budak Alicja
Zaklad Mikrobiologii Farmaceutycznej, Uniwersytet Jagielloński Collegium Medicum w Krakowie.
Med Dosw Mikrobiol. 2012;64(1):35-43.
Gram-negative bacteria belonging to the family Enterobacteriaceae cause severe and difficult to treat nosocomial infections. Strains of different species that produce extended-spectrum beta-lactamases (ESBL) were classified as alert pathogens. The purpose of this study was to analyze the occurrence and determination of antimicrobial susceptibility patterns of 134 ESBL-producing Enterobacteriaceae strains.
96 (72%) isolates of Klebsiella pneumoniae and 38 (28%) isolates of Escherichia coli, were cultured from patients of Specialistic Hospital in Krakow, in the period from 2008 to 2010. Bacterial identification and antimicrobial susceptibility testing were performed by automated system Vitek 2 Compact (bioMerieux, Poland). Condition for inclusion in the study was the production by the strains of beta-lactamases with extended substrate spectrum (ESBL), which was confirmed using the automated method (Vitek 2 Compact system) and the disc-diffusion assay (DDST). Taken into consideration the first isolate from the patient.
Bacilli of the species K. pneumoniae ESBL(+) were mainly isolated from respiratory tract samples (46%), urine (27%) and blood (12%). The dominant divisions in terms of frequency of isolation of these pathogens were anesthesiology and intensive care (42%), neurology and brain strokes (16%) and internal medicine (11%). Drugs with the highest efficiency against K. pneumoniae ESBL(+), in our in vitro studies, were: imipenem (100%), meropenem (100%), amikacin (90%) and tetracycline (75%). E. coli ESBL(+) isolates derived from patients of Anesthesiology and Intensive Care Unit (32%), Internal Medicine Unit (16%) and Division of Hematology (13%). Among all tested strains majority were obtained from respiratory tract samples, urine, swabs from wounds and blood (respectively 24%, 24%, 21% and 18%). Isolates of E. coli ESBL(+) demonstrated the greatest susceptibility in case of amikacin (92%) and piperacillin with tazobactam (76%), which suggests the highest activity of that antimicrobials against infections caused by examined strains. None of the analyzed bacilli were resistant to carbapenems.
Our study highlights the importance of characteristics of distribution of ESBL-producing K. pneumoniae and E. coli strains among hospitalized patient. Good antibiotic policies based on antibiotic resistant patterns can decrease the risk of ESBL infection.
肠杆菌科的革兰氏阴性菌可引发严重且难以治疗的医院感染。产超广谱β-内酰胺酶（ESBL）的不同菌种菌株被列为警示病原体。本研究旨在分析134株产ESBL肠杆菌科菌株的发生率及抗菌药敏模式。
2008年至2010年期间，从克拉科夫专科医院的患者中培养出96株（72%）肺炎克雷伯菌分离株和38株（28%）大肠杆菌分离株。通过自动化系统Vitek 2 Compact（波兰生物梅里埃公司）进行细菌鉴定和抗菌药敏试验。纳入研究的条件是菌株产生具有扩展底物谱的β-内酰胺酶（ESBL），这通过自动化方法（Vitek 2 Compact系统）和纸片扩散法（DDST）得以证实。考虑患者的首次分离株。
产ESBL的肺炎克雷伯菌主要从呼吸道样本（46%）、尿液（27%）和血液（12%）中分离得到。就这些病原体的分离频率而言，主要科室为麻醉学与重症监护（42%）、神经病学与中风（16%）以及内科（11%）。在我们的体外研究中，对产ESBL的肺炎克雷伯菌效率最高的药物为：亚胺培南（100%）、美罗培南（100%）、阿米卡星（90%）和四环素（75%）。产ESBL的大肠杆菌分离株来自麻醉学与重症监护病房患者（32%）、内科病房（16%）和血液科（13%）。在所有检测菌株中，大多数来自呼吸道样本、尿液、伤口拭子和血液（分别为24%、24%、21%和18%）。产ESBL的大肠杆菌分离株对阿米卡星（92%）和哌拉西林/他唑巴坦（76%）显示出最高敏感性，这表明这些抗菌药物对所检测菌株引起的感染活性最高。所分析的杆菌均对碳青霉烯类药物无耐药性。
我们的研究突出了产ESBL的肺炎克雷伯菌和大肠杆菌菌株在住院患者中分布特征的重要性。基于抗生素耐药模式制定良好的抗生素政策可降低ESBL感染风险。
