医院感染大肠埃希菌耐药性变化分析

目的 监测6年来分离的大肠埃希菌的临床分布和耐药性变化,为临床治疗大肠埃希菌引起的感染提供依据.方法 采用K-B纸片法和VITEK-2系统,对6年中分离的1 907株大肠埃希菌进行统计分析.结果 1 907株大肠埃希菌中尿液分离出1 114株（58.4%）、脓液215株（11.3%）、痰165株（8.7%）、血液159株（8.3%）;产ESBLs大肠埃希菌1999-2004年所占比率,依次为5.11%、10.34%、14.56%、15.14%、33.79%、29.96%,逐年增加,产ESBLs大肠埃希菌耐药率明显高于非产ESBLs大肠埃希菌,对环丙沙星、青霉素类、一代、二代头孢菌素耐药率较高,对阿米卡星和头孢哌酮/舒巴坦的耐药率较低,对亚胺培南耐药率为零.结论 大肠埃希菌是医院感染的主要病原菌,具有多重耐药机制,其产ESBLs株逐年增多,治疗大肠埃希菌感染时,需根据药敏试验结果结合患者病情合理地选用抗菌药物.

Changes in Antibiotic Resistance Diversity of Escherichia coli in Nosocomial Infection

OBJECTIVE With surveillance of the distribution and antibiotic resistance of Escherichia coli during the last six years in our hospital, the basis for the reasonable clinical use of antibiotic is provided to doctor. METHODS A total of 1 907 strains of E. coli isolated during the last six years were analyzed by Kirby-Bauer disk or VITEK-2 system. RESULTS Among 1 907 strains of E. coli, 1 114 strains were isolated from urine, accounted for 58.4%; 215 from pus or secret, accounted for 11.3%; 165 from sputum, accounted for 8. 7%; and 159 from blood, accounted for 8.3%. ESBLs production rate of E. coli increased steadily from 5. 11%, 10. 34%, 14. 56%, 15.14%, 33.79% to 29.96%, separately during the six years. The resistance of E. coli with ESBLs to most antibiotics was much higher than those without ESBLs. And E. coli demonstrated much higher resistant rate to ciprofloxacin, penicillins, and first or second generation cephalosporins, and much lower to amikacin and cefoperazone/sulbactam. No strains were found to be resistant to imipenem. CONCLUSIONS E. coli is the major pathogen, causing nosocomial infection with multi-resistant mechanism, since ESBLs-producing strain is increasing as years gone, reasonable choice of antibiotic should be in term of result of antibiotic resistant test and patient symptom to cure the E. coli infection induced.