產超廣譜β—內酰胺酶細菌致社區感染與醫院感染耐藥性調查分析

史瑀　穆金智　殷翠香

[摘要] 目的 探討產超廣譜β-內酰胺酶細菌致社區感染與醫院感染耐藥性分析，為指導臨床合理用藥提供依據。方法 收集2014年1月～2017年12月檢驗科細菌培養產ESBLs的大腸埃希菌、肺炎克雷伯菌、奇異變形菌以及產酸克雷伯菌的菌株，在剔除重復菌株后，進行細菌耐藥譜調查，并判斷是否為醫院感染，同時分析社區感染與醫院感染的耐藥性差異。 結果 我院2014年1月～2017年12月共檢出產ESBLs細菌共647例，社區感染598例，醫院感染49例，在對我院社區感染與醫院感染的產ESBLs大腸埃希菌耐藥率的比較中，發現醫院感染的產ESBLs大腸埃希菌對米諾環素、慶大霉素、丁胺卡那霉素、頭孢哌酮、頭孢西丁以及頭孢他啶的耐藥性要高于社區感染；醫院感染的產ESBLs肺炎克雷伯菌對米諾環素、頭孢哌酮、頭孢西丁及頭孢曲松的耐藥性要高于社區感染，并且以上差異均具有統計學意義（P<0.05）。 結論 院感工作人員應了解醫院感染與社區感染的耐藥性差異，并將結果及時反饋給臨床科室，為臨床合理使用抗菌藥物提供準確的參考。

[關鍵詞] 產超廣譜β-內酰胺酶；社區感染；醫院感染；耐藥性

[中圖分類號] R378.9 [文獻標識碼] B [文章編號] 1673-9701（2018）23-0149-04

Investigation and analysis on drug resistance to community infection and nosocomial infection caused by extended-spectrum β-lactamase producing bacteria

SHI Yu MU Jinzhi YIN Cuixiang ZHAO Jian LI Zewen

Department of Infection Monitoring， No.2 School of Clinical Medicine， Inner Mongolia University For Nationalities， Inner Mongolia Forestry General Hospital， Yakesh 022150， China

[Abstract] Objective To investigate the drug resistance of extended-spectrum β-lactamase producing bacteria in community infection and nosocomial infection， and to provide guidance for clinical rational drug use. Methods The strains of ESBLs-producing Escherichia coli， Klebsiella pneumoniae， Proteus mirabilis and Klebsiella oxysporum were collected from the bacterial cultures of the Clinical Laboratory from January 2014 to December 2017. After eliminating duplicate strains， an investigation of bacterial resistance patterns was conducted， and whether it was nosocomial infection was determined. At the same time， the differences in drug resistance between community infections and nosocomial infections were analyzed. Results A total of 647 ESBLs-producing bacteria were detected in our hospital from January 2014 to December 2017. There were 598 cases of community infection and 49 cases of nosocomial infections. In the comparison of drug resistance rates of ESBLs-producing Escherichia coli in community infection and nosocomial infection in our hospital， it was found that ESBLs-producing E. coli in nosocomial infection were more resistant to minocycline， gentamycin， amikacin， cefoperazone， cefoxitin and ceftazidime than that in community infection； the ESBLs-producing Klebsiella pneumoniae in nosocomial infection was more resistant to minocycline， cefoperazone， cefoxitin， and ceftriaxone than that in community infection. The above differences were statistically significant（P<0.05）. Conclusion The staff in nosocomial infection department should understand the difference in drug resistance between nosocomial infection and community infection. The results should be sent back to the clinical departments in a timely manner， so as to provide an accurate reference for the rational use of antimicrobial drugs in clinical practice.

[Key words] Extended-spectrum β-lactamase producing bacteria； Community infection； Hospital infection； Drug resistance

產超廣譜β-內酰胺酶（ESBLs）主要是一種由質粒介導的可以水解廣譜β-內酰胺抗生素的一種酶，主要產生于腸桿菌科細菌，如大腸埃希菌和肺炎克雷伯菌，另外在奇異變形菌與產酸克雷伯菌重也可產生但數量較少[1，2]。由于ESBLs可以在同種甚至異種細菌間逐代傳播，并且可以引起醫院感染的流行，因此必須加強對產ESBLs細菌耐藥性的監測[3]。本研究收集內蒙古林業總醫院產ESBLs細菌，并對其進行社區感染與醫院感染的診斷，并分析社區感染與醫院感染耐藥譜的差別，為醫院感染監測提供相關預警資料，同時對抗菌藥物的使用提供數據支持。……