产超广谱β-内酰胺酶大肠埃希菌的耐药性分析及其产酶的危险因素调查  

The drug resistance analysis of E. Coli which produces super-broad spectrum β-lactanmase and the risk factors associated with its β-lactamase productivity

作　　者：李雪清[1] 朱凤霞[1] 李小林[1] 刘烁秋[1] 梁成典 

机构地区：[1]民航总医院,北京100025 [2]北京市隆福医院

出　　处：《北京医学》2006年第7期408-411,共4页Beijing Medical Journal

摘　　要：目的探讨超广谱β"内酰胺酶(ESBLs)细菌产生的因素,为防止其传播及治疗提供依据。方法依据美国2005年临床和实验室标准协会(CLSI)和2003年美国临床实验室标准化委员会(NCCLS)推荐的纸片扩散法(KB法)及VITEK"Jr仪器法,收集民航总医院和北京隆福医院2003年1月至2005年12月分离的住院患者不同标本的大肠埃希菌155株,对其进行耐药性检测;随机选择大肠埃希菌感染患者129例,其中产ESBLs者41例,不产ESBLs者88例,对其进行治疗用药的溯源调查。结果3年内在所测的155株大肠埃希菌中,检出产ESBLs大肠埃希菌59株,检出率38.1%;所有产ESBLs大肠埃希菌对亚胺培喃和阿米卡星敏感,对呋喃妥因、哌拉西林/他唑巴坦、头孢西丁的耐药率低于10%,且3年的逐年耐药率无太大变化。连续使用抗生素时间越长、连续用药次数越多、使用三代头孢、联合用药和多次更换用药均易造成细菌产ESBLs。结论产ESBLs大肠埃希菌对亚胺培南、阿米卡星、呋喃妥因、哌拉西林/他唑巴坦、头孢西丁的敏感率高于90.0%,对其他抗生素具有较高的交叉耐药性和多重耐药性。抗生素应用的时间、次数、种类和联合用药等因素可使产ESBLs大肠埃希菌的检出率增加。Objective To explore the factors associated with super-broad spectrum β-1actamase productivity of E. Coli and the measures to prevention of its spread and treatment. Methods 155 E. Coli strains isolated grow various specimens of in-patients admitted to the Minbang General Hospital and Beijing Longfu Hospital during Jan 2003 to Dec 2005 were analysed. The drug resistance of these strains were analysed based on the Clinical and Laboratory Standards Institute （CLSI） and KB method recommended by NCCLS at 2003. 129 cases with E. Coli infection were selected randomly, in which 41 cases with E, Coli strains that produce ESBLs, 88 strains did not produce ESBLs. The antibiotics used by these cases were recorded. Results 59 ESBLs producing E. Coli were isolated from the 155 E. Coil strains during the 3 years. The isolation rate was 38.1%. All ESBLs producing strains were sensitive to imipenium and amikacin and the resistance rate to nitrofurantion piperacillin/tazobactam, eefoxitin was less than 10 %. The resistance rate remained almost the same in the 3 years. Prolonged continuous use of antibiotics, high freguency of antibiotics usage, the use of the third generation cephalosporins, combination of antibiotics and frequent changes of antibiotics could induce the emergence of ESBLs producing strains. Conclusions The sensitivity of ESBLs producing strains to impenium amikacin, nitrofurantion, piperacillin/tagobactam and cefoxitin is higher than 90.0% but the strains themselves are cross-resistant and multi-resistant to other antibiotics. The time, times, category and combination of antibiotics can increase the frequency of ESBLs producing E. Coli.

关 键 词：耐药性 大肠埃希菌 超广谱Β-内酰胺酶 

分 类 号：R446.5[医药卫生—诊断学]