磷霉素氨丁三醇对尿标本中肠杆菌科细菌体外抗菌活性研究

目的了解磷霉素氨丁三醇对尿标本中肠杆菌科细菌的体外抗菌活性，指导临床合理用药。方法采用ATB系统对中段尿标本分离的1185株肠杆菌科细菌进行鉴定，纸片扩散法进行药敏试验和ESBI．S的检测，结果按CLSI2012年版标准判断；应用WHONET5．6软件分析病原菌的分布及耐药情况。结果1185株肠杆菌科细菌对磷霉素氨丁三醇的敏感率为90．8％，其中大肠埃希菌929株（78．4％）、肺炎克雷伯菌124株（10．5％）和奇异变形杆菌69株（5．8％）对磷霉素氨丁三醇的敏感率分别为93．1％、88．7％和79．7％。住院患者尿标本分离的肠杆菌科细菌对磷霉素氨丁三醇的敏感率低于门诊患者（87．0％对92．7％）。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌ESBLs的检出率分别为54．4％、38．7％和23．2％。产ESBLs的大肠埃希菌和肺炎克雷伯菌对磷霉素氨丁三醇的敏感率分别为89．5％和87．5％。结论尿标本培养获得的肠杆菌科细菌以大肠埃希菌为主，磷霉素氨丁三醇对尿标本分离的产ESBLs的大肠埃希菌和肺炎克雷伯菌的肠杆细菌科细菌具有良好的体外抗菌活性，可作为临床经验用药之一。

In vitro activity of fosfomycin tromethamine against Enterobacteriaceae isolates from urine

Objective To explore the in vitro activities of antimicrobial agents including fosfomycin tromethamine against Enter- obacteriaceae isolates from urine samples and provide evidence for reasonable use of antibiotics. Methods A total of 1 185 Enter- obacteriaceae isolates from midstream urine samples were identified by ATB system. Antimicrobial susceptibility and ESBLs production were tested by Kirby-Bauer method. The results were analyzed according to the breakpoints of CLSI 2012. WHO- NET 5.6 software was used to retrospectively analyze the distribution and antibiotic susceptibility of pathogenic bacteria. Re- suits Overall, about 90.8% of the 1 185 isolates tested were susceptible to fosfomycin tromethamine. The top three species of bacteria showing the highest suceptibility rate to fosfomycin tromethamine were Escherichia coli （93. 1%）, Klebsiella pneu moniae （88.7%）, and Proteus spp. （79.7%）. The Enterobacteriaeeae isolates from urine samples of inpatients were less s us- ceptibe to the antimicrobial agents tested compared to the isolates from outpatients （87. （）/00 versus 92.7 % susceptible）. ESBLs were identified in 54.4% of Escherichia eoli, 38.7% of Klebsiella pneumoniae and 23.20//00 of Proteus strains. The ESBL-pro- ducing E. coli （89.5 e/o ） and K. pneumoniae （87.5 %） were highly susceptible to fosfomycin tromethamine. Conclusions Esch- erichia coli is the most popular Enterobacteriaceae isolated from urine samples. Fosfomycin tromethamine has good in vitro an- tibacterial activity against Enterobacteriaceae strains, including ESBLs-producing E. coli and K. pneurnoniae. Fosfomycin tromethamine is a valuable therapeutic option for urinary tract infections.