产超广谱β-内酰胺酶大肠埃希菌检出率及耐药性分析

目的了解2007～2009年产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的检出率及对抗菌药物的耐药情况。方法细菌培养分离采用常规方法,细菌鉴定应用VTECK-2全自动细菌鉴定分析仪。ESBLs菌株采用双纸片确认法检测,药敏试验采用纸片扩散(K-B)法,按美国临床实验室标准化协会(CLSI)规定标准进行。结果 3年内从临床感染标本中共分离获得1510株大肠埃希菌,产ESBLs百分率为57.5%;各年度产ESBLs检出率分别为54.4%、55.5%和63.0%。产酶菌对头孢呋辛、头孢曲松、头孢他啶几乎全部耐药,对氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率分别为40.0%、10.0%和1.0%左右,对环丙沙星和阿米卡星耐药率分别为70.0%以上和20.0%左右,对亚胺培南和美罗培南全部敏感。结论 2007～2009年产ESBLs大肠埃希菌检出率呈上升趋势,产酶菌对含酶抑制剂复合抗菌药物的耐药性也呈上升趋势,这与近几年来头孢类抗菌药物在临床广泛、大量应用有关,应引起临床医生高度重视。对产酶菌引起的重度感染应首选碳青霉烯类抗菌药物治疗。

Detection rate and drug resistance of ESBLs-producing Escherichia coli

Objective To study lhe deteelion rate and drug resistance of extended-spectrum β-laetamases （ES- BLs）in Escherichia coli during the last thrcc years in a hospital. Methods The conventional methods were employed for the cultivation,isolation and detection of bacteria, and the VTECK-2 analyzer was also used for the automatic identification. The double-disk synergy test was performed to confirm ESBLs-producing strains,and Kirby-Bauer（K- B） method, was used for the antimicrohial susceptihility test in accordance with the standard issued by Clinical and Laboratory Standards Institute（CLSl）. Results 1 510 Escherichia coli strains were isolated in specimens collected from the patients in last three years,and the prevalence of ESBLs was 57.5%. The annual detection rate of ESBLs was 54.4%,55. 50%,63.0% respectively. ESBI.s producing＇strains were found to have resistance to almost all of cefuroxime, ceftriaxone and ceftazidime. The resistance rate to ampieillin/sulbactam, piperacillin/ tazobactam, cefoperazone/ sulbaetam, ciprofloxaein, amikaein, imipenem and meropenem was 40%, 10%, 1%, 70%, 20 %, 0% and 0 % respectively. Conclusion The detection rate of ESBI.s producing Eseherichia eoli is on the rise in the hospital during last three years. To β-1aetamase inhibitors as composite antimicrobial agents, the drug resistance of ESBLs-producing Escheriehia eoli also shows an upward tendency. This is owing to extensive and abundant clinical application of cepha-losporin antibiotic drugs in recent years. Therefore more attention should be paid to by clinical doctors. The severe in--fected patients caused by ESBLs-producing Escherichia coli should be preferentially used carbopenems for treatment.