革兰氏阴性杆菌的AmpC酶检测与其药物敏感率分析  

Emergence of AmpC enzyme and antibiotic sresistance in gram-negative bacilli

作　　者：刘文恩[1] 江源[2] 唐银[1] 王红梅[1] 

机构地区：[1]中南大学湘雅医院检验科,长沙410008 [2]中南大学湘雅医学院检验系,长沙410008

出　　处：《中南大学学报（医学版）》2006年第1期134-137,共4页Journal of Central South University ：Medical Science

摘　　要：目的:探讨湘雅医院革兰氏阴性杆菌AmpC酶产生与其耐药性的关系,为临床提供选药参考。方法:应用M icroscan微生物自动鉴定系统进行细菌鉴定与药敏试验,并应用纸片扩散法进行AmpC酶检测。结果:204株革兰氏阴性杆菌中AmpC酶阳性菌株40株,阳性率为19.61%;AmpC酶阳性菌株与AmpC酶阴性菌株药敏结果显示,前者大多对头孢曲松、哌拉西林、头孢他啶、头孢噻肟、头孢哌酮、氨曲南、哌拉西林/他唑巴坦、头孢呋肟、头孢他啶/棒酸、头孢噻肟/棒酸耐药,而后者大多对上述药物敏感,两者比较,差异有统计学意义(均P<0.05)。而两者大多对头孢吡肟、亚胺培南、美洛培南、头孢哌酮/舒巴坦、左氟沙星及阿米卡星敏感。结论:AmpC酶检测有助于耐药菌株的检出,AmpC酶阳性菌株大多对第三代头孢菌素及酶抑制剂及氨曲南耐药,对亚胺培南、美洛培南、头孢吡肟、头孢哌酮/舒巴坦、左氟沙星及阿米卡星敏感,可为临床经验治疗提供参考。Objective To investigate the relationship between emergence of AmpC enzyme and drug resistance in the gram-negative bacilli in Xiangya Hospital and to provide information for the treatment of antibiotics. Methods The bacteria were identified; the susceptibility was determined by Microscan microbiological identification system; and the AmpC enzyme was detected by disc diffusion method. Results Of the 204 gram-negative strains, the positive rate of AmpC enzyme was 19.61% ; AmpC-positive strains resisted to ceftriaxone, piperacillin, ceftazidime, cefotaxime, cefoperazone, aztreoham, piperacillin/tazobactam, cefuroxime, ceftazidime/clavulanic, and cefotaxime/clavulanic. But AmpC-negative strains were susceptible to those antibiotics. There were significant differences, between the two groups （ All P 〈 0. 05 ）. Both groups were susceptible to cefepime, imipenem, meropenem, cefoperazone/sulbactam,levofloxacin, and amikacin. Conclusion The detection of AmpC enzyme is helpful to the screen of drug resistant strains. Most bacilli with AmpC enzyme show the resistance to thirdgeneration cephosporins, aztreonam, and the beta-lactamase inhibitors, but susceptible to imipenem, cefepime, meropenem, cefoperazone/sulbactam, levofloxacin, and amikacin, which provides the information for the antibiotic therapy.

关 键 词：AMPC酶 耐药 革兰氏阴性杆菌 

分 类 号：R446.5[医药卫生—诊断学]