鲍曼不动杆菌的高产AmpC酶、ESBLs及其耐药性分析

目的了解鲍曼不动杆菌高产AmpC酶、超广谱β-内酰胺酶（ESBLs）产生情况及其耐药谱。方法用K—B法进行药物敏感性检测，按表型确证试验检测ESBLs，按表型筛选法检测高产AmpC酶。结果93株鲍曼不动杆菌主要分离自呼吸内科、神经外科，以痰或咽拭子、创面或伤口分泌物、尿3类标本多见，检测到15株（16．1％）产高产AmpC酶菌株，10株（10．8％）产ESBLs菌株，产酶株均呈多重耐药，对第3代头孢菌素、青霉素类及氨曲南耐药率明显高于非产酶菌株，未发现亚胺培南耐药株。结论产高产AmpC酶、产ESBLs酶是鲍曼不动杆菌多重耐药的原因之一，应加强对产酶株的检测，以指导临床合理应用抗生素，防止其暴发流行。

Detection of highly producing AmpC enzymes, extended-spectrum β-lactamases and drug resistance in Acinetobacter baumannii

Objective To study the drug resistance and production status of highly producing AmpC enzymes, extended-spectrum β-lactamases (ESBLs) and drug resistance in Acinetobacter bau-mannii. Methods Drug sensitivity test was performed with Kirby-Bauer method. ESBLs were detected with phenotype confirmatory test (double-disk synergy test), and highly producing AmpC enzymes were measured with phenotype screening method. Results 93 strains of Acinetobacter baumannii were mainly obtained from respiratory department and neurosurgery, and isolated from sputum/pharyngeal stab, raw surface/wound secretion and urine samples. 15 strains (16.1%) of highly producing AmpCenzyme-producing Acinetobacter baumannii were detected, so were 10 strains (10. 8%) of ESBLs-pro-ducing isolates. All enzymes-producing strains displayed multi-resistant, and their resistant rates to the third cephalosporin, penicillins and aztreonam were much higher than enzymes non-producing ones. None was detected resistant to imipenem. Conclusion Occurrence of highly producing AmpC en-zymes and extended-spectrum β-lactamases (ESBLs) is one of causes for Acinetobacter baumannii multi-resistance. It suggests that detection of ESBLs-producing isolates should be strengthened so as to prevent their outbreak and spread.