我院2012年10月-2013年3月革兰阴性杆菌产ESBLs和AmpC酶检测及耐药性分析

目的:了解我院产超广谱β-内酰胺酶(ESBLs)和头孢菌素酶(AmpC)革兰阴性杆菌的耐药性,为临床合理用药提供参考。方法:收集我院2012年10月-2013年3月临床分离出的革兰阴性杆菌。用头孢硝噻吩纸片检测革兰阴性杆菌产β-内酰胺酶情况,双纸片法检测产ESBLs情况,头孢西丁三维试验检测产AmpC酶情况,以确定产酶表型。用K-B法进行药敏检测。结果:103株革兰阴性杆菌中,单产AmpC酶菌42株(40.8%),单产ESBLs菌21株(20.4%),同时产ESBLs和AmpC酶菌12株(11.7%)。大肠埃希菌和肺炎克雷伯菌对含酶抑制剂复方制剂如哌拉西林/他唑巴坦,以及碳青霉烯类抗生素亚胺培南和氨基糖苷类抗生素阿米卡星的耐药率均较低。非发酵菌铜绿假单胞菌和鲍曼不动杆菌对各抗生素耐药率均较高。结论:各革兰阴性杆菌产酶菌株对多种抗生素的耐药率较高,产ESBLs和AmpC酶可能是导致革兰阴性杆菌耐药的主要机制之一。

Detection and Drug Resistance Analysis of ESBLs and AmpC Enzyme Producing Gram-negative Bacilli Isolated from Our Hospital during Oct. 2012--Mar. 2013

OBJECTIVE： To explore the drug resistance of ESBLs and AmpC enzyme producing Gram-negative bacilli in our hospital, and to provide reference for rational drug use in the clinic. METHODS： Gram-negative bacilli were isolated from the hos- pital during Oct. 2012 to Mar. 2013. Nitrocefin paper assay was used to detect the situation of producing fl-lactamase Gram-negative bacteria. Double-disk assay was used to detect ESBLs, and cefoxitin three-dimensional test was adopted to detect the emergence of AmpC enzyme in order to determine enzyme phenotype. K-B method was used for susceptibility test. RESULTS： Among 103 Gram-negativebacilli, there were 42 strains producing AmpC enzyme （40.8%）, 21 strains producing ESBLs （20.4%）, and 12 strains producing ESBLs and AmpC enzyme （11.7%）. Escherichia coli and Klebsiella pneumonia had low drug resistance to Com- pound preparation containing enzyme inhibitors as piperacillin/tazobactam, and carbapenem antibiotics as imipenem and aminoglyco- side amikacin. The non-fermenting bacteria P aeruginosa and A. baumannii had high resistance to each antibiotic. CONCLU- SIONS： The most enzyme producing Gram-negative bacilli stains show high drug resistance to various antibiotics. Producing ES- BLs and AmpC enzymes may be one of the main causes to antibiotics resistance of Gram-negative bacilli.