头孢他啶与头孢替坦对产ESBL肠杆菌耐药表型及交叉耐药情况分析

目的通过头孢他啶(CAZ)、头孢替坦(CTT)对产超广谱β内酰胺酶(ESBL)大肠埃希菌(ECO)和肺炎克雷伯菌(KPN)的耐药情况并根据分布图进行相关性分析,探讨该两种抗菌药物在临床上的应用。方法采用Whonet5.6软件对分别对2012-2015年间分离出的1 311株ECO(750株产ESBL)和898株KPN(306株产ESBL)进行CTT与CAZ的耐药表型分析,并用实验解释结果分布图分析两种抗菌药物间的关系。结果 ESBL+KPN对CAZ耐药性为41.2%,对CTT耐药性为14.1%,差异具有统计学意义(P0.05)。ESBL+ECO对CAZ的耐药性为34.6%,对CTT耐药性为1.1%,差异具有统计学意义(P0.05)。在ESBL-菌株中也存在相同现象。CAZ在ESBL+KPN菌株中最低抑菌浓度(MIC)平均值最高为6.39μg/mL,在ESBL-KPN菌株中最低为1.37μg/mL。CTT平均MIC值也在ESBL+KPN菌株中最高,在ESBL-KPN菌株中最低。CAZ与CTT在所有菌株中MIC范围分别是1~64、4~64μg/mL;CAZ与CTT在ESBL-菌株交叉敏感率均在90.0%以上,交叉耐药率在5.0%以下。ESBL+菌株中交叉敏感率低于70.0%,其中ESBL+KPN菌株CAZ与CTT交叉耐药率高达13.4%。结论抗菌药物交叉敏感性及耐药性结果对于指导临床选药或换药具有重要的临床意义。

Resistant phenotype and correlation analysis of ESBL-producing enterobacteriaceae between Cefotetan and Ceftazidime

Objective To explore the clinical application of antibiotics Ceftazidime(CAZ) and Cefotetan(CTT)by analysis susceptibility and scatter of the CAZ adn CTT against Escherichia coli(ECO) and Klebsiella pneumoniae(KPN).Methods The drug sensitivity analysis of 1 311 strains of ECO and 898 strains of KPN isolated from 2012 to 2015 and the relationship between CAZ and CTT was analyzed by using the Whonet 5.6 software.Results The resistance rate of ESBL+ KPN to CAZ was 41.2％ and the rate to CTT was 14.1％,the difference was statistically significant(P<0.05).The resistance rate of ESBL+ ECO to CAZ was 34.6％ and the rate to CTT was 1.1％,the difference was statistically significant(P<0.05).The average value of MIC of CAZ was highest in group of ESBL+KPN,it was 6.39 μg/mL.And it was lowest in group of ESBL-KPN,it was 1.37 μg/mL.The average value of MIC of CTT was highest in group of ESBL+KPN,it was 6.8 μg/mL.And the lowest was in group of ESBL-KPN.The range of MIC of CAZ was 1-64 μg/mL,and the range of CTT was 4-64 μg/mL in all groups.The cross sensitivity of CAZ and CTT was more than 90.0％.The cross resistance was less than 5.0％.The cross sensitivity of CAZ and CTT was less than 70.0％ in ESBL+ group.And the cross resistance was up to 13.4％.Conclusion The cross resistance and cross sensitivity of the two antibiotics is very important in guiding clinical antibiotic selection or replacement.