医院内G-杆菌产酶检测及耐药性分析

目的了解医院常见G-杆菌的产酶及耐药情况为临床控制感染提供依据。方法收集2002-01～12住院病人分离的对三代头孢菌素至少有一种耐药的易产酶G-杆菌,采用传统K-B法进行药物监测,并使用改良的三维试验法检测细菌产酶情况。结果所监测大肠埃希菌与肺炎克雷伯杆菌超广谱β-内酰胺酶(ESBLs)的检出率为94.0%、100%,大肠埃希菌AmpC的检出率为3.0%;易产诱导酶阴沟肠杆菌、产气肠杆菌、弗劳地枸橼酸杆菌、粘质沙雷菌、奇异变形杆菌ESBLs检出率分别为47.0%、86.0%、80.0%、100%、40.0%。其中阴沟肠杆菌、产气肠杆菌、弗劳地枸橼酸杆菌AmpC酶的检出率为29.0%、14.0%、13.0%;鲍曼不动杆菌AmpC的检出率为33.0%;另外有7.0%的弗劳地枸橼酸杆菌、3.0%的大肠埃希菌产SSBL。亚胺培南是治疗严重易产酶细菌感染的首选药物。结论G-杆菌存在严重耐药,要正确区分细菌产酶机制,为临床控制感染提供正确的依据。

Surveillance on phenotypes of enzyme-producing antibiotic-resistant gram-negative bacillus in hospital infection

Objective To investigate the drug-re sistance of gram-negative bacillus in hospital infection and its enzyme-producing activity.Methods Drug-resistance of191strains of gram-negative bacillus was tested by disk diffusion method and the phenotype of beta-lactamases(BLs)were tested by using three-dimensional test.Result The detectable rates of producing extra-spectrum(ESBLs )bacteria from E.coli,K.pneumonie,S.marcescens,E.cloacae,E.aerogenes,C.freundii and P.mirabilis were94.0%,100%,100%,47.0%,86.0%,80.0%and40.0%respectively.The detectable rate of producing AmpC bacteria from E.cloacae,E.aerogenes,C.freundii and E.coli were29.0%,14.0%,13.0%and3.0%respectively;33.0%of Acineto-bacter baumannii hyperproduced AmpC were detected.Besides7.0%of C.freundii and3.0%of E.coli hyperproduced SSBL.Imipenem was the first selected drug to treat the serious infectious disease.Conclusion Most of gram-negative bacillus in hospital are seriously resistant to drug.So it is very important to studying phenotypes of enzyme-producing of gram-negative bacillus to control infections.