阴沟肠杆菌的临床分布及耐药性分析

目的了解医院阴沟肠杆菌（Enterobacter cloacae,ECL）的临床分布情况及其对常用抗生素的耐药率,为临床合理使用抗生素提供依据。方法对医院2010年4月~2011年8月检出的55株阴沟肠杆菌进行药敏和超广谱β-内酰胺酶（extended spectrumβ-lactamase,ESBLs）检测,抗生素敏感测定采用K-B琼脂扩散法,产ESBLs的检测采用双纸片确认法。结果 55株阴沟肠杆菌在临床的分布以痰液为主,占49.0%,感染主要发生在重症监护病房、泌尿外科和呼吸内科。阴沟肠杆菌对美罗培南（美平）和亚胺培南（泰能）无耐药,对头孢哌酮/舒巴坦有较低的耐药率,耐药率为7.27%,对头胞噻肟、氨苄青霉素和头孢唑啉有较高的耐药率,耐药率为80.0%、100%和100%。ESBLs阳性株耐药率在头胞噻肟、头孢吡肟、头胞他啶（复达欣）、庆大霉素和头孢西丁比ESBLs阴性株高,差异有统计学意义（P〈0.05）;在头孢哌酮/舒巴坦、丁胺卡那、哌拉西林/他唑巴坦和环丙沙星的耐药率,差异无统计学意义（P〉0.05）。结论应加强对阴沟肠杆菌,特别是ESBLs阳性株耐药性的监测,根据药敏试验结果合理选用抗生素是非常重要。

Distribution and drug resistance of Enterobacter cloacae

Objective To understand the clinical distribution of resistance of Enterobacter cloacae（ECL）in hospital and provide foundation for clinical use of antibiotics.Methods The drug susceptibility and extended spectrum β-lactamase（ESBLs）of 55 Enterobacter cloacae strains detected from April 2010 to August 2011 were determined.The drug susceptibility of Enterobacter cloacae was tested by using disc diffusion method（K-B）.The ESBLs-producing strains were confirmed by double disk synergy test.Results 49.0% of the 55 Enterobacter colacae strains in clinical specimens were in the sputum specimen of ICU,urinary surgery and respiratory departments.The strains were still susceptible to meropenem and imipenem and the resistan rate to cefoperazone/sulbactam was 7.27%.The resistant rates to cefotaxime,ampicillin and cefazolin were 80.0%,100% and 100%respectively.The resistant rates of positive ESBLs strains to cefotaxime,cefepime,ceftazidime,gentamicin and cefoxitin were higher than those negative ESBLs strains,showing statistically significant difference（P0.05）.The rates of drug resistance of positive strains of ESBLs and negative strains of ESBLs to cefoperazone/sulbactam,amikacin,piperacillin/tazobactam and ciprofloxacin were not staistically different.Conclusion The monitoring of Enterobacter cloacae,ESBLs-positive strain in particular,should be strengthened and clinical use of antibiotics be based on susceptiblity test results.