阴沟肠杆菌感染的临床特点及耐药性分析

[目的]探讨2004-2008年我院分离的阴沟肠杆菌的耐药性及临床感染特点.[方法]采用K-B法进行了16种常用抗生素的药敏试验,用头孢西丁三维试验,头孢曲松三维试验及其酶抑制试验进行了AmpC酶及其ESBL的检测.[结果]阴沟杆菌在我院的感染以呼吸道为主,占63.1%;科室分布以脑外科（50.6%）为主,骨科（20.0%）次之.2004-2008年的药敏结果显示,以亚胺培南耐药率最低,其次是头孢哌酮,舒巴坦和哌拉西林,他唑巴坦,新型喹诺酮类药物加替沙星、左氧沙星也有较好的抗菌活性,但耐药率在逐年上升.三代、四代头孢菌素对阴沟肠杆菌的耐药率也在逐年升高,2008年均超50%.ESBL从2004年的17.8%（7/41）上升至2006年的26.1%,AmpC酶由2004年的20.0%上升至2008年的32.3%,逐年上升.[结论]为控制耐药菌株的扩散和流行,应加强细菌的检测,重视药敏结果,合理使用抗生素,做好细菌的耐药性监测.

Analysis on the clinical characteristics and drug resistance of enterobacter cloacae

[ Objective] To explore the characteristics of clinical infection and drug resistance of Enterobacter cloacae isolated in our hospital from 2004 to 2008. [Methods] Drug resistance tests of 16 kinds of common antibiotics were determihed by K-B method. Cefoxitin three dimensional tests, ceftriaxone three dimensional tests and corresponding enzyme inhibitory tests were adopted to detect AmpC enzyme and ESBL. [Results] Among the infections caused by Enterobacter cloacae, respiratory tract infection accounted for 63.1%. As to its distribution among departments, neurosurgery was in the first place, accounting for 50.6%, while orthopedics was in the second place, accounting for 20.0%. The results of the antimicrobial susceptibility tests from 2004 to 2008 indicated,that the drug resistance rates to imipenem, cefoperazone/sulbactam, piperacillin/tazobactam were comparatively low, however, the drug resistance rates to quinolones like gatifloacin, levofloxacin, ciprofloxacin were increasing year by_year, although, to some extents, they could still inhibit Enterobacter cloacae well. The drug resistance rates to the third generation and forth generation cephalosporins were also increasing year by year. ESBL producing strains increased from 17.8% in 2004 to 26.1% in 2008, AmpC enzyme producing strains increased from 20.0% in 2004 to 32.3% in 2008, increasing year by year [Conclusions] In order to control extended-spectrum enzymes （ESBL, AmpC enzyme, metalloenzyme and so on） we should enhance the dctecthon drug resistance of bacteria ,pay attention to the results of antimierobial susceptibility tests and use antibiotics rationally.