产气肠杆菌的临床分布及耐药性分析

目的 了解医院感染产气肠杆菌在临床的分布及其耐药现状,为临床合理使用抗菌药物提供依据.方法 对近3年临床分离的138株产气肠杆菌,用K-B法检测对16种抗菌药物的耐药性,用三维试验检测AmpC酶和ESBLs.结果 菌株分离最多的临床科室是ICU、烧伤科、呼吸内科、泌尿外科和肝胆外科；检出率最高的标本是痰液、咽拭子、血液和创面；产气肠杆菌对青霉素类和三代头孢菌素的耐药率74.6％～99.3％,四代头孢菌素的耐药率也高达53.6％,未发现对亚胺培南和美罗培南耐药株,头孢哌酮/舒巴坦和哌拉西林/他唑巴坦耐药率仅为8.0％和25.4％;此外,喹诺酮类药物药耐率较低,为2.9％～5.1％,氨基糖苷类药物在17.4％～48.6％,磺胺甲恶唑/甲氧苄啶的耐药率为74.6％；三维试验产ESBLs菌和产AmpC的检出率分别为22.5％和29.7％,有13株菌同时产ESBLs和AmpC酶.结论 产气肠杆菌已成为医院感染重要病原菌之一,且耐药率日趋严重,对高危病区应完善和落实各项预防措施,严格无菌操作,加强对易感患者的监测.

Clinical distribution and drug resistance of Enterobacter aerogenes

OBJECTIVE To study clinical distribution and drug resistance of Enterobacter aerogenes and provide basis for the rational use of antibiotics.METHODS We collected 138 strains of E.aerogenes in the last three years and tested the drug resistance to 16 kinds of antibiotics by means of K-B methods and tested AmpC enzyme and ESBLs by means of three dimensional test.RESULTS Most of the strains were collected from ICU,burn department,respiratory department,urology department and liver and gall surgical department;the detection rates of the isolates were the highest from the specimen like sputum,throat swab,blood and wound;the drug susceptibility testing showed that the drug resistance rate of E.aerogenes to penicillin and the third generation of cephalosporins were 99.3% and 74.6%,the resistance rate to the fourth generation of cephalosporins was 53.6%,no imipenem or meropenem-resistant strains were found,the resistance rates to cefoperazone/sulbactam and piperacillin/ tazobactam were only 8.0% and 25.4%;the resistance rates to quinolones were relatively low,varying from 2.9% to 5.1%,the resistance rates to aminoglycoside were between 17.4% and 48.6%,and the resistance rate to trimethoprim-sulphamethoxazole was 74.6%;the detection rates of ESBLs-producing strains and the AmpC were 22.5% and 29.7%,respectively,there were 13 strains producing both ESBLs and AmpC enzyme.CONCLUSION E.aerogenes has become the major species of pathogens causing nosocomial infections,and the drug resistance is increasingly serious,so we should fulfill preventive measures in high risk wards and strengthen strict aseptic operation and the surveillance for susceptible population.