产超广谱β-内酰胺酶细菌筛选方法及临床应用探讨  

作　　者：高恒强[1] 朱海燕[1] 李艳华[1] 张延强[1] 李鹏[1] 朱艳蓉[1] 

机构地区：[1]聊城市人民医院,山东聊城252000

出　　处：《山东医药》2006年第11期15-16,共2页Shandong Medical Journal

基　　金：聊城市科技局资助项目(2003013.6)

摘　　要：目的探讨三种超广谱β-内酰胺酶(ESBLs)筛选方法检测产ESBLs大肠埃希菌(EC)和肺炎克雷伯菌(KP)的可靠性。方法以头孢三嗪(CFT)、头孢噻肟(CTX)、头孢他啶(CAZ)和氨曲南(ATM)为指示底物,用双纸片协同试验(DDS)、三维试验和双纸片增效试验(IPDD)检测95株EC、14株KP(其中45株ESBLs阳性,64株ESBLs阴性)。结果三种方法的敏感性分别为86.7%、95.6%、84.4%,特异性分别为100%、98.5%、100%,检测效率分别为94.5%、97.3%、93.6%。结论三维试验是一种敏感、可靠的ESBLs筛选方法,但操作繁琐,标本量较少时适用;DDS和IPDD操作简便、结果可靠,适合于各级医院。Objective： To evaluate the reliability of three ESBLs screening methods for the detection of strains of E. coil and K. pneumoniae that produce ESBLs, and determine the prevalence in our hospital of strains producing ESBLs among E. coli and K. pneumoniae. Methods：Using a set of 45 ESBLs-producing and 64 nonESBLs-produeing strains of E. coli and K. pneumoniae, we compared three screening methods （a double- disk synergy test, a three-dimensional test and a double-disk enhancement test） for ESBLs detection, and also determined the prevalence of strains producing ESBLs among 74 E. coli and 31 K. pneumoniae isolates from clinical samples. Results. Sensitivity, specificity and agreement were found to be 86.7%, 1000% and 94. 5% respectively for the double-disk synergy test, and 95. 6%0, 98. 5% and 97. 3% respectively for the threedimensional test and 84. 4%, 100% and 93. 6% respectively, for the double-disk enhancement test. The prevalence of ESBLs in isolates of E. coli and K. pneumoniae recoverd from patients in our hosbital was 32.4 and 25. 8% respectively, Optimal indicators were ceftriaxone and cefotaxime for detecting ESBLs. Conclusions： The most sensitive and reliable method is the three-dimensional test among three screening methods for the detection of ESBLs in E, coli and K, pneumoniae, The three-dimensional test wais suitable for only screening strains producing ESBLs in routine in small hospital, The double-disk synergy test and the double-disk enhancement test are suitable for screening strains producing ESBLs in routine in all hospitals,

关 键 词：Β-内酰胺酶类 大肠埃希菌 肺炎克雷伯菌 医院感染 

分 类 号：R978.1[医药卫生—药品]