阴沟肠杆菌的产酶性及抗菌药物的体外联合抗菌活性研究

目的 探讨咸阳地区阴沟肠杆菌的产酶现状及其抗菌药物的应用.方法 收集2012年6月-2013年5月临床分离无重复的100株阴沟肠杆菌,采用KB琼脂扩散法检测超广谱β内酰胺酶（ESBLs）和通过改良三维试验检测AmpC,碳青霉烯酶的检测采用亚胺培南＋ EDTA法,MIC检测采用微量倍比稀释法,按CLSI法规进行.结果 在100株阴沟肠杆菌中,产ESBLs酶的为49％,产AmpC酶的为29％,碳青霉烯酶的为0％,同时产ESBLs和AmpC酶为29％.药敏结果是哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、美洛培南、头孢吡肟、环丙沙星、阿米卡星和头孢他啶的抑菌率分别为64.7％,58.8％,100％,70.6％,70.6％,64.7％,41.1％.联合药物头孢吡肟、哌拉西林/他唑巴坦、美洛培南、头孢哌酮/舒巴坦与阿米卡星对阴沟肠杆菌的协同及相加作用分别为（17.64-41.18）％,（11.76-47.06）％,（5.88-52.94）％和（0-58.83）％.联合药物头孢吡肟、哌拉西林/他唑巴坦、美洛培南、头孢哌酮/舒巴坦与环丙沙星对阴沟肠杆菌协同及相加作用分别为（11.76-23.54）％,（5.88-11.77）％,（11.77-47.06）％和（5.88-17.65）％.结论 产酶的阴沟肠杆菌在该地区处于一个相对较高的水平,因此临床医师应根据药敏结果选用抗菌药物.

Study on Capability of Producing Enzyme of Enterobacter Cloace and Antibacterial Activity of Combined Antibacterials in Vitro

Objective To study the Xianyang region＇s Enterobacter cloace enzyme production and application of antimicrobial drugs.Methods Collected in June 2012 to May 2013 clinical separation,no repeat 100 bead sewer Enterobactercloacae.The K B super broad spectrum extended spectrum β lactamases （ESBLs） and modified three dimensional of cefiriaxone test were used to detect AmpC,carbapenems enzyme medthod of detection with imipenem and EDTA.Results Isolate 100 strains from clinical specjmens of infection of sewer Enterobacter cloacae,including producing ESBLS enzyme was 49 ％.Production of AmpC enzyme was 29 ％.Carbapenems enzyme was 0 ％,at the same time,producing ESBLS AmpC enzyme was 29 ％,and piperacillin/tazobactam,cefoperazone/sulbactam,meropenem,cefepime ciprofloxacin,amilacin and ceftazidime bacteriostatic rates totally were 64.7％,58.8％,100％,70.6％,70.6％,64.7％ and 41.1 ％,respectively.Combination of drugs cefepime,piperacillion/tazobactam,meropenem,cefoperazone/sulbactam and amikacin to sewer synergy and the processing effect of en terobacter cloacae were 17.64％-41.18％,11.76％-47.06％,5.88％-52.94％ and 0-58.83％,respectively.Combina tion of drugs cefepime,piperacillion/tazobactam,meropenem,cefperazone/sulbactam and ciprofloxacin on sewer synergy and the processing effect of enterobacter cloacae were 11.76％-23.54％,5.88％-11.77％,11.77％-47.06％ and 5.88％- 17.65％,respectively.Conclusion Enzyme production of sewer enterobacter cloacae in the region was in a relatively high level,so clinicians should select different antimicrobial agents according to the results of drug susceptibility.