医院感染与社区获得性感染革兰阴性杆菌耐药性与β-内酰胺酶的分布对比  

β-Lactamases Produced by Gram Negative Bacilli in Hospital Infections or Community Acquired Infections: Comparison of Antibiotic Resistance and Distribution

作　　者：方平[1] 潘晓龙[1] 周东升[1] 吴同生[1] 吴祥林[1] 

机构地区：[1]铜陵市人民医院,安徽铜陵244000

出　　处：《中华医院感染学杂志》2006年第3期335-339,共5页Chinese Journal of Nosocomiology

基　　金：安徽省铜陵市卫生局基金资助(200404)

摘　　要：目的 了解铜陵地区医院感染（HI）和社区获得性感染（CAI）在病原菌分布、细菌的耐药性及产生β-内酰胺酶概率的差异性，以指导抗菌药物的合理使用。方法 收集铜陵地区5所医院2003年10月1日～2004年9月30日。所有临床标本分离的革兰阴性杆菌作为受试菌，药敏试验采用Kirby-Bauer法进行，采用三维试验检测革兰阴性杆菌产ESBLs和AmpC酶。纸片协同法检测MBL。结果 356株革兰阴性杆菌HI267株，占75．0％，CAI89株，占25．0％；HI标本主要来源于痰或气管分泌物（53．9％），CAI标本主要来源于尿液（34．8％）；CAI组敏感率普遍高于HI组，356株革兰阴性杆菌检出产ESBLs和AmpC酶77株，总检出率为21．6％，HI69株，检出率25．8％，CAI8株，检出率9．0％。结论 铜陵地区革兰阴性杆菌耐药性严重，HI组敏感率明显低于CAI组，且产生多种β-内酰胺酶。OBJECTIVE To investigate the resistance rates of Gram negative bacilli and the distribution of β-lactamases in hospital infections （HI） or community acquired infections （CAD in Tongling. METHODS Antimicrobial susceptibility test was done on 356 strains of Gram negative bacilli isolated in Tongling from Oct 2003 to Sep 2004 by Kirby-Bauer method. The detection of ESBLs and AmpC β-lactamases was performed by three-dimensional test, MBL by the double-disk synergy test. RESULTS Among total 356 strains of Gram negative bacilli, 267 were with HI （53.9%） isolated from sputum of patients, 89 （34.8%） were isolated from CAI patients and urine. The antimicrobial susceptibility rates of Gram negative bacilli from CAI patients was significantly higher than that from HI patients, for Acinetobacterbaumannii they were 1.5 to 3.0, for Pseudomonas aeruginosa were 1.2 to 1.6. No strains of Escherichia coli and Klebsiella pneumoniae were found resistant to imipenem. Among 356 Gram negative bacilli, 77 strains hyperproducing ESBLs and AmpC β-lactamases, the detection rate was 21.6%, 69 strains were isolated from HI patients, and 8 strains were from CAI patients. From strains resistant to imipenem had 13 strains detected MBL, the detection rate was 52.0 %. All of them were isolated from HI patients. CONCLUSIONS The resistance of Gram negative bacilli is a serious problem in Tongling. The antimicrobial susceptibility rates of Gram negative bacilli from CAI patients are significantly higher than those from HI patients. Gram negative bacilli produce all kinds of β-lactamases, such as ESBLs, AmpC β-lactamases and MBL.

关 键 词：Β-内酰胺酶 革兰阴性杆菌 耐药性 医院感染 社区获得性感染 

分 类 号：R379.9[医药卫生—病原生物学]