产AmpC酶革兰阴性杆菌的分布与耐药性研究

目的了解产AmpC酶革兰阴性杆菌的分布及其耐药特征,指导临床合理使用抗菌药物. 方法采用双纸片法检测了493株革兰阴性杆菌的AmpC酶,并用仪器法测定了产酶菌对17种抗菌药物的耐药性. 结果革兰阴性杆菌产AmpC酶总阳性率为38.3%,以铜绿假单胞菌和阴沟肠杆菌为主,分别占产酶菌的54.0%和24.3%;病区分布以重症监护病房为最高(34.4%),感染部位以呼吸道多见(55.6%);产AmpC酶菌对青霉素类和一至三代头孢类抗菌药物耐药率高达37%～100%;对亚胺培南、头孢吡肟和哌拉西林/他唑巴坦的耐药率较低,在9%～28%之间;其他抗菌药物耐药率各有差异. 结论产AmpC酶革兰阴性杆菌有较严重的耐药性,合理使用抗菌药物十分重要.

Resistance Surveillance of Gram-negative Bacilli Producing AmpC Enzyme

OBJECTIVE To investigate the outbreak and resistance of Gram-negative bacilli producing AmpC enzyme. METHODS A total of 493 strains of Gram-negative bacilli were detected the AmpC enzyme by a double-disk test, and the strains of producing AmpC enzyme were determined resistance by autoscan-4. RESULTS The positive rate of AmpC enzyme was 38.3%, the prevalence of Pseudomonas aeruginosa and Enterobacter cloacae was ~54.0% and 24.3%, respectively. Most strains (34.4%) were detected in intensive care units, the common infection site was lung. The resistance rate of AmpC enzyme producing strains to penicillins and the first, second and third-generations cephalosporins was 37-100%. and it had less resistance rate to imipenem, cefepime, piperacillin/tazobactam. CONCLUSIONS Gram-negative bacilli producing AmpC enzyme are seriously resistant. It is very important to select antibiotics correctly for infection according to the results of susceptibility tests.