112株阴沟肠杆菌产碳青霉烯酶、AmpC酶及产ESBLs的检测与耐药性分析

目的 探讨济宁医学院附属医院阴沟肠杆菌产碳青霉烯酶、AmpC酶、产ESBLs的情况及对17种常用抗菌药物的耐药性,以指导临床合理选择抗菌药物.方法 收集医院2009年5月-2010年5月临床分离的非重复阴沟肠杆菌112株,采用改良的Hodge试验对碳青霉烯酶进行检测,采用头孢西丁三维试验对AmpC酶进行检测,采用表型确证试验对产ESBLs进行检测,K-B纸片扩散法进行药敏试验.结果 112株阴沟肠杆菌主要来自痰液,占60.7％,其次为分泌物及尿液,分别占16.1％、13.4％;从112株阴沟肠杆菌中检出碳青霉烯酶阳性2株,阳性率1.8％,AmpC酶阳性60株,阳性率53.6％,产ESBLs菌46株,阳性率41.1％,其中有28株仅携带ESBLs,42株仅携带AmpC酶,18株同时携带产ESBLs和AmpC酶.结论 应加强对产碳青霉烯酶阴沟肠杆菌的控制和检测;阴沟肠杆菌产ESBLs和AmpC酶携带率高;临床治疗应在药敏试验的基础上,针对不同的产酶株合理选择抗菌药物.

Detection of CHBls,ESBLs and AmpC in 112 strains of Enterobacter cloacae and analysis of the drug resistance

OBJECTIVE To evaluate the production of CHBls,ESBLs and AmpC in clinical specimens-derived Enterobacter cloacae from the affiliated hospital of jining medical college and analyze the drug resistance to 17 common antibiotics,so as to guide rational use of antibiotics in clinical practice.METHODS A total of 112 non-repeated strains of E.cloacae were isolated in our hospital from May 2009 to May 2010.Modified Hodge test was applied to detect CHBls.AmpC was checked by cefoxitin three-dimensional test.Phenotypic confirmatory test was used to detect ESBLs.The drug susceptibility test was performed by Kirby-auer method.RESULTS The 112 strains of E.cloacae were mainly isolated from sputum,accounting for 60.7%,followed by secretions and urine,accounting for 16.1% and 13.4% respectively.Positive rates of CHBls,AmpC and ESBLs in the 112 strains of E.cloacae were 1.8%(2 strains),53.6%(60 strains) and 41.1%(46 strains),respectively.In these strains,28 strains(25.0%) only had ESBLs,42 strains(37.5%) only had AmpC,and 18 strains(16.07%) had both ESBLs and AmpC.CONCLUSION We should enhance the detection and control of E.cloacae producing CHBls.There are very high positive rates of ESBLs and AmpC produced by E.cloacae.Clinical therapy should based on drug susceptibility test and antibacterials are rationally selected according to different enzyme-producing E.cloacae.