1999-2010年产ESBLs大肠埃希菌的感染分布及耐药性分析

目的 了解医院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(ECO)的临床分布特点及对抗菌药物的耐药性,为临床合理选用抗菌药物提供依据.方法 对1999年1月-2010年12月临床分离的5106株ECO进行回顾性分析,菌株鉴定采用法国生物梅里埃公司的API和VITEK-2系统,药敏试验采用K-B纸片扩散法,耐药性分析采用WHONET5.4软件,双纸片协同试验及纸片扩散确证试验检测ELBLs.结果 产ESBLs ECO检出率由1999年的16.27％上升至2010年的55.70％；ECO主要分离自尿液,占29.13％,其次是血液及痰,占20.06％及18.36％；主要来源于外科病区和内科病区；与非产ESBLs ECO比较,产ESBLs菌对阿米卡星、左氧氟沙星等非β-内酰胺酶类抗菌药物的耐药率均显著增高,差异有统计学意义(P＜0.01),产与非产ESBLs ECO对亚胺培南和美罗培南均保持高度敏感,耐药率均＜1.00％.结论 产ESBLs ECO检出率呈逐年上升趋势；产ESBLsECO表达对包括非β-内酰胺类在内的抗菌药物多药耐药；产ESBLs ECO对抗菌药物的耐药性高于非产ESBLsECO,对碳青霉烯类抗菌药物仍保持高度敏感性.

Distribution of ESBLs-producing Escherichia coliinfections and drug resistance during 1999-2010

OBJECTIVE To investigate the clinical distribution and the drug resistance of ESBLs-producing Escherichia coli(E.coli) and thereafter provide bases for reasonable selection of antibiotics in the clinical practice.METHODS We retrospectively analyzed 5106 clinical isolates of E.coli from Jan 1999 to Dec 2010,the strains were identified by API and VITEK-2 system of Bio-Merieux of France,the drug susceptibility testing was determined by Kirby-Bauer method,the antimicrobial resistance was analyzed by WHONET 5.4 software.Double-disc synergy test and disk diffusion confirmatory test were employed to detect extended-spectrum β-lactamases.RESULTS The detection rate of ESBLs-producing E.coli increased from 16.27% in 1999 to 55.70% in 2010,respectively;E.coli strains were mainly isolated from urine,accounting for 29.13%,followed by the blood(20.06%) and sputum(18.36%);the majority of the strains were isolated from surgery and medicine wards;as compared with non-ESBLs-producing E.coli,the resistance rates of ESBLs-producing E.coli to non-β-lactamase antibiotics such as amikacin and levofloxacin significantly increased,with statistical significance(P<0.01),both ESBLs-producing and non-ESBLs-producing E.coli isolates were highly susceptible to imipenem and meropenem,the drug resistance rates were less than 1.00%.CONCLUSION The detection rate of ESBLs-producing E.coli increases year by year;ESBLs-producing E.coli shows multidrug resistance to antibiotics including non-β-lactam antibiotics;the drug resistance rate of ESBLs-producing E.coli is higher than that of non-ESBLs-producing E.coli,which remain highly susceptible to carbapenems.