加硼酸或氯唑西林的改良Hodge试验检测肠杆菌科细菌碳青霉烯酶的研究

目的 探讨加硼酸或氯唑西林的改良Hodge试验在碳青霉烯酶类药物敏感性降低的细菌中检测碳青霉烯酶的临床应用价值.方法 收集2009年～2010年南京军区总医院对碳青霉烯酶类药物敏感性降低(亚胺培南、美罗培南或厄他培南的MIC≥2 μg/ml)的肠杆菌科细菌65株;采用琼脂倍比稀释法测定其对亚胺培南、美罗培南和厄他培南的MIC;通过改良Hodge试验和加硼酸或氯唑西林的改良Hodge试验检测碳青霉烯酶;采用PCR检测多种β-内酰胺酶基因,并对PCR阳性产物测序鉴定.结果 65株临床分离菌中,53株菌对亚胺培南不敏感(MIC＞4 μg/ml),51株菌对美罗培南不敏感(MIC＞4 μg/ml),58株菌对厄他培南不敏感(MIC＞2 μg/ml).65株菌中38株改良Hodge试验阳性,包括7株弱阳性和31强阳性;33株加硼酸或氯唑西林的改良Hodge试验阳性,包括改良Hodge试验弱阳性2株和强阳性31株.经过对菌株进行β-内酰胺酶基因PCR和测序,发现加硼酸或氯唑西林的改良Hodge试验阳性菌株均携带blaKPC-2;32株阴性菌株均未携带碳青霉烯酶酶基因,但其中5株改良Hodge试验弱阳性菌株携带blampC/blaESBL.结论 加硼酸或氯唑西林的改良Hodge试验可快速、有效地区分改良Hodge试验的真、假阳性,是检测肠杆菌科细菌碳青霉烯酶的简便可靠方法,适用于临床微生物实验室.     

肠杆菌科产碳青霉烯酶菌株筛选试验方法的研究

目的 评价肠杆菌科产碳青霉烯酶菌株纸片扩散初筛试验与改良Hodge试验的符合性,为基层实验室常规开展产碳青霉烯酶菌株检验提供依据.方法 收集临床分离的34株对碳青霉烯类抗生素敏感性降低的分离株,采用纸片扩散法检测其对厄他培南、亚胺培南、美罗培南的耐药性;通过改良Hodge试验检测碳青霉烯酶.结果 34株临床分离株经纸片扩散法检测对厄他培南为全部耐药;对美罗培南29株耐药,5株敏感;对亚胺培南25株耐药,1株中介,8株敏感.通过改良Hodge试验检测碳青霉烯酶34株菌中有21株阳性;厄他培南、美罗培南、亚胺培南耐药株与Hodge试验阳性株的符合率分别为61.8%、72.4%、80.8%.结论 以亚胺培南作为初筛底物对筛选产碳青霉烯酶菌株的特异度更高,亚胺培南耐药菌株应高度怀疑是产碳青霉烯酶株.     

耐碳青霉烯类肠杆菌科细菌表型检测及其耐药性研究

目的了解耐碳青霉烯类肠杆菌科细菌(CRE)感染状况及其产酶类型。方法采用最低抑菌浓度(MIC)法分析肠杆菌科细菌的耐药情况。采用厄他培南纸片扩散法初筛产碳青霉烯酶菌株,对初筛阳性菌株分别采用改良Hodge试验、加硼酸或苯唑西林的改良Hodge试验、EDTA亚胺培南复合纸片法进行表型确证。结果肠杆菌科细菌对亚胺培南和美罗培南的耐药率分别为2.7%、2.3%。厄他培南纸片扩散法初筛阳性菌株11株,其中改良Hodge确证试验阳性(或弱阳性)菌株3株,包括产金属酶菌株1株,产超广谱β-内酰胺酶(ESBLs)或AmpC酶菌株2株。2株改良Hodge确证试验弱阳性菌中未检出碳青霉烯酶基因,但检出AmpC、TEM、CTX-M基因,改良Hodge试验阳性菌中检出blaIMP基因。结论改良Hodge试验、加硼酸或苯唑西林改良Hodge试验及EDTA亚胺培南复合纸片法相结合进行碳青霉烯酶检测,在暂无条件开展基因分型的医院具有很好的应用前景。     

耐碳青霉烯类肠杆菌科细菌KPC和NDM-1β内酰胺酶耐药基因的研究

目的检测江苏盛泽医院耐碳青霉烯类肠杆菌科细菌的KPC和NDM-1耐药基因,分析耐碳青霉烯类的耐药机制。方法采用改良Hodge试验、亚胺培南-EDTA纸片协同试验和AmpC酶三维试验检测29株耐碳青霉烯类抗生素肠杆菌科细菌产酶情况;用PCR方法检测KPC及NDM-1两种碳青霉烯酶耐药基因。结果29株分离菌中,26株菌改良Hodge试验阳性,7株亚胺培南EDTA纸片协同试验阳性,7株AmpC酶三维试验阳性,16株携带KPC型碳青霉烯酶耐药基因,未扩增出NDM-1碳青霉烯酶耐药基因。结论该院耐碳青霉烯类抗生素肠杆菌科细菌的耐药机制主要是携带KPC型碳青霉烯酶基因。     

亚胺培南不敏感大肠埃希菌碳青霉烯酶基因的检测

目的 了解碳青霉烯酶基因在亚胺培南不敏感大肠埃希菌中的分布情况.方法 收集亚胺培南不敏感的大肠埃希菌25株,K-B纸片法测定菌株对药物的敏感性;采用EDTA协同试验及改良Hodge试验进行碳青霉烯酶表型检测;PCR法扩增碳青霉烯酶基因并进行序列分析.结果 25株大肠埃希菌呈现泛耐药现象,其中亚胺培南耐药15株,中度敏感10株;改良Hodge试验阳性1 5株,金属酶表型试验全部阴性;15株菌株检出KPC-2酶基因,未检出其它碳青霉烯酶基因.结论 产KPC-2酶是造成该院大肠埃希菌对碳青霉烯类抗菌药物耐药的主要原因.     

低产碳青霉烯酶肠杆菌科细菌的筛选及耐药基因检测

目的:了解临床分离碳青霉烯类表型敏感的肠杆菌科细菌碳青霉烯酶耐药基因携带情况。方法:VITEK-2系统进行药物的最低抑菌浓度(MIC)检测;改良Hodge试验(MHT)筛查低产碳青霉烯酶肠杆菌科细菌;EDTA双纸片增效法检测金属β-内酰胺酶(MBL);PCR法检测相关耐药基因。结果:115株实验菌有12株MHT阳性;12株阳性菌中,3株EDTA双纸片增效试验阴性,9株阳性,这9株菌除阿米卡星、多粘菌素B敏感外,其他抗菌药物均呈耐药,含I类整合子,且检出IMP-4(blaIMP-4)和IMP-1(blaIMP-1)型的MBL基因,未检出KPC型碳青霉烯酶基因及其他MBL基因。结论:厄他培南对肠杆科细菌产碳青霉烯酶的筛选比亚胺培南、美洛培南敏感;经MHT筛选阳性的,潜在产碳青霉烯酶的肠杆科细菌,应进一步用基因检测法确认。     

改良Hodge试验检测肠杆菌科细菌中碳青霉烯酶的研究

目的 用改良Hodge试验(MHT)检测肠杆菌科细菌碳青霉烯酶的产生,了解碳青霉烯酶基因分布.方法 从浙江大学医学院附属第二医院、浙江省东阳市人民医院、北京医院和四川大学附属华西医院4家医院收集3 718株肠杆菌科细菌,用纸片法检测细菌对厄他培南的敏感性,用MHT检测碳青霉烯酶的产生情况,并用PCR扩增常见的碳青霉烯酶基因.结果 4家医院的肠杆菌科细菌对厄他培南的不敏感率为3.04％ (113/3718),上述4家医院的不敏感率依次为5.09％、2.15％、2.59％和1.72％.MHT的总阳性率为2.29％ (85/3718),4家医院的阳性率依次为4.73％、1.21％、1.06％和1.58％.113株厄他培南不敏感菌株中,MHT阳性82株,阴性31株.85株MHT阳性菌株中,82株对厄他培南耐药或中介耐药,仅有3株敏感.82株MHT阳性、厄他培南不敏感的菌株中,肺炎克雷伯菌碳青霉烯酶(KPC)基因阳性65株,亚胺培南水解酶(IMP)基因阳性15株,其中2株KPC和IMP同时阳性,其他4株未扩增到常见碳青霉烯酶基因.31株MHT阴性、厄他培南不敏感的菌株和3株MHT阳性、厄他培南敏感的菌株均未扩增到常见碳青霉烯酶基因.结论 MHT可有效地检测肠杆菌科细菌中的碳青霉烯酶,具有敏感性高、假阳性率低的特点.肠杆菌科细菌所产碳青霉烯酶主要为KPC,其次为IMP.     

碳青霉烯类非敏感肠杆菌的耐药性与基因型研究

目的研究碳青霉烯类非敏感肠杆菌的耐药性与基因型。方法自2013年6月至2014年6月采集碳青霉烯类非敏感肠杆菌共计110株,选用K-B纸片分析细菌对药物有无敏感性,采用改良后的Hodge试验分析碳青霉烯细菌在临床上的使用反应。测试菌株耐药基因对BLAST对比(局部序列比对)与PCR、DNA进行分析测试。结果测试出替加环素中介11株和耐药4株(黏质沙雷菌、产气肠杆菌2株)。110株碳青霉烯类非敏感肠杆菌对头孢噻肟和阿莫西林/克拉维酸耐药率最高,头孢他啶、四环素、复方磺胺甲噁唑、亚胺培南、厄他培南、环丙沙星、氨曲南等耐药率均为64.9%~88.4%;而妥布霉素、阿米卡星、呋喃妥因、头孢吡肟耐药率较低,为16.6%~40.1%;敏感率增高的为替加环素、米诺环素,分别为82.0%和86.6%。研究发现110株碳青霉烯类非敏感肠杆菌当中,检测出blaSHV-12、blaCTX-M-15、ESBLs、blaCTX-M-33等基因。在110株碳青霉烯细菌当中还检测出1株黏质沙雷菌,基因型号为blaKPC-2;改良后的Hodge试验77株阳性,检出率为70%。36株(32.7%)ESBLs呈阳性,5株阴沟肠杆菌(blaIMP-26)与1株产气肠杆菌(blaVIM-2)基因、31株大肠埃希菌。结论碳青霉烯肠杆菌的基因型主要有blaKPC-2基因、blaIMP-26基因、blaVIM-2基因。药敏结果显示碳青霉烯类肠杆菌科细菌对米诺环素和替加环素敏感率增高,临床用药时可根据患者病情进行合理选择,以达到控制感染的效果。     

耐碳青霉烯类抗生素产气肠杆菌的KPC-2酶检测与分析

目的 了解分离自临床标本的耐碳青霉烯类抗生素产气肠杆菌的耐药机制.方法 对临床分离到非重复的16株厄他培南耐药,及亚胺培南耐药或敏感性减低的产气肠杆菌采用改良Hodge试验和聚合酶链反应(PCR)检测KPC酶及其KPC酶基因,并采用转移接合试验对KPC酶基因阳性的菌株进行转移接合.结果 对16株产气肠杆菌的改良Hodg...     

耐碳青霉烯类抗菌药物大肠埃希菌耐药机制的研究

目的了解河南省人民医院耐碳青霉烯类抗菌药物大肠埃希菌的耐药特点和耐药机制。方法收集临床送检合格样本分离到的细菌,采用BD Phoenix 100微生物分析系统进行细菌鉴定及体外药物敏感性分析,依照美国临床实验室标准化协会(CLSI)标准筛选出耐碳青霉烯类大肠埃希菌。采用改良Hodges和美罗培南(MEM)-乙二胺四乙酸(EDTA)-Na2双纸片协同试验进行表型筛选。聚合酶链反应(PCR)检测耐药基因blaKPC、blaNDM、blaVIM、blaIMP、blaOXA-48。对blaKPC阳性菌株进行接合转移试验。结果从1 238株大肠埃希菌中筛选到8株耐碳青霉烯类菌株,7株对亚胺培南(IPM)、MEM均耐药,有1株仅对MEM耐药。8株改良Hodges试验均为阳性,6株双纸片协同试验阳性。2株携带blaKPC-2,3株携带blaIMP-4。blaKPC-2可以发生接合转移。结论首次在河南省人民医院发现产blaIMP-4的大肠埃希菌,其耐碳青霉烯类抗菌药物的机制主要为携带blaKPC-2和blaIMP-4,blaKPC-2基因可以通过质粒水平传播。     

mCIM 与eCIM 筛选肠杆菌科细菌碳青霉烯酶的效果评价

目的评价改良碳青霉烯类失活法(modified carbapenem inactivation method,m CIM)和EDTA碳青霉烯类失活法(EDTAcarbapenem inactivation method,e CIM)对肠杆菌科细菌碳青霉烯酶表型的筛选能力。方法分别收集碳青霉烯类耐药和敏感肠杆菌科细菌102株和53株,采用m CIM和e CIM进行碳青霉烯酶表型筛选试验,PCR法检测blaKPC-2、blaNDM-1、blaIMP-4、blaVIM-1和blaOXA-48耐药基因,并对表型筛选试验结果与基因检测结果的一致性进行统计分析。结果 102株碳青霉烯类耐药肠杆菌科细菌中97株检出耐药基因,包括51株blaKPC-2基因、38株blaNDM-1基因、5株blaIMP-4基因以及3株同时携带blaKPC-2和blaNDM-1基因;m CIM检出阳性98株,阴性4株。98株m CIM阳性菌中,e CIM阳性46株,阴性52株。53株碳青霉烯类敏感肠杆菌科细菌耐药基因检测及m CIM试验均为阴性。m CIM试验筛选碳青霉烯类耐药肠杆菌科细菌碳青霉烯酶产生的敏感性为99.0%,特异性为96.6%,与PCR结果一致性Kappa值为0.959;e CIM筛选金属酶敏感性为93.5%,特异性为94.6%,Kappa值为0.881;e CIM筛选丝氨酸碳青霉烯酶敏感性为92.6%,特异性为95.8%,Kappa值为0.882。结论 m CIM试验与e CIM试验联合检测,不仅可以有效筛选碳青霉烯酶产酶株,而且可同时区分碳青霉烯酶类型,对流行病学调查研究及疾病治疗有重要意义。     

Comparative in vitro activities of carbapenem antimicrobial agents against 264 penicillin-resistant Streptococcus pneumoniae isolates from Korea

We compared in vitro activities of carbapenems against 264 penicillin-resistant Streptococcus pneumoniae (PRSP) isolates. The MIC(50)/MIC(90) (microg/mL) values of imipenem, meropenem, ertapenem, and panipenem were 1/1, 0.25/0.25, 0.25/0.5, and 0.125/0.25, respectively. The susceptibility rates to imipenem, meropenem, and ertapenem were 0%, 85.2%, and 99.6%, respectively. Compared with imipenem and meropenem, ertapenem and panipenem had better in vitro activities against PRSP.     

碳青霉烯类非敏感肠杆菌科细菌分子流行病学研究

摘要：目的：调查碳青霉烯类抗生素非敏感肠杆菌科细菌的流行情况,并研究其耐药性传播方式。 方法：收集本院临床分离的碳青霉烯类抗生素非敏感肠杆菌科细菌34株,用Vitek2 Compact系统进行细菌鉴定和常规药敏检测,改良Hodge试验筛选产碳青霉烯酶菌株,用肠杆菌基因间重复一致序列(enterobacterial repetitive intergenic consensus,ERIC)-PCR进行分子流行病学调查。PCR扩增Int 1、Int 2、Int 3整合酶基因,质粒接合和消除试验研究细菌耐药基因的传播方式。 结果：19株细菌改良Hodge试验阳性。来自7个不同科室的12株大肠埃希菌和17株阴沟肠杆菌可以分为3种和6种基因型,来自4个不同科室的5株肺炎克雷伯菌只有1种基因型。27株菌Int1基因阳性,未检出Int2和Int3基因。除骨科1株阴沟肠杆菌外,其余33株细菌质粒消除和接合试验均成功。 结论：本院碳青霉烯类抗生素非敏感肠杆菌科细菌主要发生在外科各科室;所有肺炎克雷伯菌和泌尿外科大肠埃希菌属同一基因型,表明此类菌株呈局部流行;碳青霉烯类抗生素非敏感肠杆菌科细菌耐药性主要通过质粒传播。     

Pharmacodynamic modeling of carbapenems and fluoroquinolones against bacteria that produce extended-spectrum beta-lactamases

BACKGROUND: Bacteria that produce extended-spectrum beta-lactamases (ESBLs) are resistant to penicillins,cephalosporins, and monobactams. The results of clinical studies suggest that the carbapenems imipenem and meropenem may be effective against bacteria that produce ESBLs, although it is not known whether the new once-daily carbapenem ertapenem or the fluoroquinolones are useful against infections caused by ESBL-producing bacteria. OBJECTIVE: The present study compared the simulated pharmacodynamics of the carbapenems imipenem,meropenem, and ertapenem; the simulated pharmacodynamics of the fluoroquinolones levofloxacin, gatifloxacin, and ciprofloxacin with those of the carbapenems; and the simulated pharmacodynamics of levofloxacin 750 mg with those of levofloxacin 500 mg, all against gram-negative isolates that did and did not produce ESBLs METHODS: Pharmacokinetic data were obtained from studies in healthy humans. Minimum inhibitory concentrationsMICs) for bacteria that did and did not produce ESBLs were determined in triplicate using broth-microdilution techniques as recommended by National Committee for Clinical Laboratory Standards guidelines. Monte Carlo simulation was used to construct pharmacodynamic models for imipenem, meropenem, ertapenem, levofloxacin, gatifloxacin, and ciprofloxacin. Pharmacodynamic measures of interest were the probability of the free concentration remaining above the MIC >-40% of the time (T>MIC > or =40%) for carbapenems and the likelihood of achieving a free AUC:MIC ratio > or =125 for fluoroquinolones. RESULTS: MICs were determined for 39 isolates that produced ESBLs and 45 isolates that did not Bacteria that did not produce ESBLs were > or =93% susceptible to all carbapenems and fluoroquinolones tested. Among bacteria that produced ESBLs, rates of susceptibility to the specific agents were as follows: imipenem, 100%; meropenem, 97%; ertapenem, 87%; levofloxacin, 54%; gatifloxacin, 44%; and ciprofloxacin, 36%. In the pharmacodynamic models, imipenem and meropenem had an equal likelihood of achieving a free T>MIC > or =40% against bacteria that produced ESBLs (> or =97%) and bacteria that did not produce ESBLs (> or =98%). In contrast, the likelihood of ertapenem achieving a free T>MIC > or =40% was lower against bacteria that produced ESBLs (78%) than against bacteria that did not produce ESBLs (94%). Similarly, the fluoroquinolones were less likely to achieve a free AUC:MIC ratio > or =125 against bacteria that produced ESBLs (2%-13%) than against bacteria that did not produce ESBLs (85%-91%). CONCLUSIONS: Carbapenems had superior in vitro activity against bacteria that produced ESBLs compared with fluoroquinolones. Pharmacodynamic modeling based on local ESBL-producing isolates and pharmacokinetic data from healthy humans indicated that imipenem and meropenem may have a greater likelihood of achieving pharmacodynamic targets against bacteria that produce ESBLs than ertapenem or fluoroquinolones.     

耐亚胺培南革兰阴性杆菌产碳青霉烯酶研究

目的 了解细菌产碳青霉烯酶及其对亚胺培南、美罗培南等碳青霉烯类抗生素耐药性之间的关系。方法 应用改良Hodge Test和乙二胺四乙酸（EDTA）协同试验法对2003．6～2004．5收集自复旦大学华山医院的耐亚胺培南革兰阴性杆菌进行碳青霉烯酶筛选。blaVIM-1、blaVIM-2、blaIMP-2、blaIMP-2、blaSPM、blaOXA-23为引物进行PCR扩增，并对PCR扩增阳性产物进行DNA测序分析。结果 在75株耐亚胺培南的铜绿假单胞菌中，共检出产VIM-2型金属13内酰胺酶菌株2株（2／75），在10株耐亚胺培南的假单胞菌属细菌中检出2株产VIM-2型金属13内酰胺酶（2／10），均为恶臭假单胞菌；耐亚胺培南的8株弗劳地柠檬酸杆菌和6株不动杆菌中全部分别检出IMP金属酶新亚型和OXA-23型碳青霉烯酶。结论 细菌产碳青霉烯酶是不动杆菌和弗劳地柠檬酸杆菌对亚胺培南和美罗培南等碳青霉烯类抗生素耐药的主要原因之一，但对铜绿假单胞菌而言，产碳青霉烯酶不是导致其对亚胺培南耐药的主要原因。     

Doripenem (S-4661), a novel carbapenem: comparative activity against contemporary pathogens including bactericidal action and preliminary in vitro methods evaluations

OBJECTIVES: To investigate the potency of doripenem, a broad-spectrum carbapenem characterized by a wider spectrum of activity combining antimicrobial and bactericidal features of imipenem and meropenem. METHODS: This parenteral compound was studied against recent clinical isolates (2001-2002) from a worldwide organism collection. A total of 902 strains were susceptibility tested by reference methods against doripenem and six to 28 comparators including ertapenem, imipenem and meropenem. The organisms tested included: Enterobacteriaceae (281 strains), Acinetobacter spp. (33), Pseudomonas aeruginosa (35), Stenotrophomonas maltophilia (36), other non-fermenters (22), Haemophilus influenzae (61), Moraxella catarrhalis (33), oxacillin-susceptible staphylococci (39), enterococci (84), streptococci (163), various anaerobes (98), and other Gram-positive species such as Corynebacterium and Bacillus spp. (17). RESULTS: Against Enterobacteriaceae, the average doripenem MIC90 was 0.03 mg/L (range, < or =0.015-0.25 mg/L). Doripenem was two- to 16-fold more potent than imipenem and comparable to ertapenem and meropenem; all doripenem MIC values with enteric bacilli were < or =4 mg/L. Doripenem was active against Aeromonas (MIC50, 0.03 mg/L), Bacillus spp. (MIC50, 0.03 mg/L) and all tested anaerobic species (MIC range, < or =0.015-4 mg/L), but was less active against S. maltophilia (MIC90, >32 mg/L) and Enterococcus faecium (MIC90, >32 mg/L) among the enterococcal species. Time-dependent bactericidal action was observed for doripenem and broth MIC results were slightly greater when compared to agar MIC results. In pilot testing, the optimal doripenem disc concentration was 10 microg, identical to standardized reagents for other clinically available carbapenems. CONCLUSIONS: Doripenem appears to be a potent carbapenem with a spectrum resembling currently marketed antipseudomonal carbapenems, but with greater activity when tested against some non-fermentative bacillary strains. Continued evaluation of doripenem against isolates resistant to other beta-lactams appears to be warranted.     

53株耐碳青霉烯类药物粘质沙雷菌的耐药表型分析

目的研究耐碳青霉烯药物粘质沙雷菌的耐药表型。方法收集南京大学医学院附属鼓楼医院2018年6月~2019年9月临床分离的235株非重复粘质沙雷菌,采用Vitek 2 Compact配套GN13药敏板卡和纸片扩散法进行药物敏感性检测;采用改良碳青霉烯酶灭活试验(mCIM)和EDTA-改良碳青霉烯酶灭活试验(eCIM)对碳青霉烯酶表型进行筛选;采用PCR及测序分析检测碳青霉烯酶基因携带情况。结果235株粘质沙雷菌中检出同时对美罗培南和亚胺培南耐药菌株53株(22.6%)。53株碳青霉烯类耐药菌株中对头孢他啶敏感和中介分别为23株(43.4%)和21株(39.6%),对头孢曲松、氨曲南、环丙沙星、左氧氟沙星的耐药率均大于98%,对阿米卡星、复方新诺明的耐药率分别为1.7%和1.6%。mCIM均阳性,eCIM阳性3株。53株耐药菌株中检出blaKPC-2基因51株,检出blaNDM-1基因1株,同时携带blaKPC-2和blaNDM-1基因1株,未检出blaIMI、blaOXA48、blaFOX、blaIMP和blaVIM基因。结论本院耐碳青霉烯粘质沙雷菌检出率较高,blaKPC-2基因是介导本院粘质沙雷菌对碳青霉烯类药物耐药的主要流行基因型。     

Comparative in vitro antimicrobial activity of a new carbapenem, E1010, and tentative disc diffusion test interpretative criteria.

The susceptibility of 705 bacterial isolates representing 46 different species to E1010 (ER-35786), imipenem, meropenem and cefepime was determined by the NCCLS broth microdilution test. The MIC(90)s for E1010 were < or =1.0 mg/L for Enterobacteriaceae, fastidious Gram-negative bacteria, streptococci and anaerobes. E1010 was two- to four-fold more active than imipenem and meropenem against Pseudomonas aeruginosa, and four-fold more active than the other carbapenems against methicillin-resistant Staphylococcus aureus. Vancomycin-resistant enterococci and most Enterococcus faecium were resistant to all four drugs tested. The NCCLS disc diffusion test was performed simultaneously on the non-fastidious organisms. Assuming the MIC breakpoints for E1010 will be the same as for the other carbapenems, the disc diffusion zone diameter breakpoints of imipenem and meropenem would also be applicable to E1010.     

肠杆菌科细菌碳青霉烯酶的检测

目的调查本院肠杆菌科细菌产碳青霉烯酶的情况。方法收集2010年1～5月临床分离的肠杆菌科细菌,采用K-B纸片法进行药敏试验,以三代头孢菌素、亚胺培南、美罗培南为检测药物,筛选出可能产碳青霉烯酶的菌株120株,采用改良的Hodge试验进行确证。结果在120株耐一种或多种三代头孢菌素,提示可能产生碳青霉烯酶的肠杆菌科细菌中,通过表型确证试验确证为阳性的细菌有4株,肺炎克雷伯菌2株,大肠埃希菌1株,弗劳地枸橼酸杆菌1株。结论表型确证试验阳性的细菌中,如需准确辨别亚型,最好用分子生物学方法检测基因序列。