社区及医院感染大肠埃希菌产AmpC酶、ESBLs检测与耐药性分析  

Detection of AmpC and ESBLs of Escherichia coli from community and nosocomial infection and the drug-resistance analysis

作　　者：唐朝贵[1] 郑绍同[1] 孙海平[1] 韩其香[1] 傅启云[1] 

机构地区：[1]南京医科大学附属淮安第一医院,江苏淮安223300

出　　处：《中国感染控制杂志》2007年第4期255-258,共4页Chinese Journal of Infection Control

摘　　要：目的探讨引起社区和医院感染的大肠埃希菌产AmpC酶、超广谱β-内酰胺酶(ESBLs)情况及其对常用抗菌药物的耐药性,以指导临床合理选择抗菌药物。方法采用头孢西丁酶提取物三维试验测定AmpC酶;双纸片协同试验和纸片确证试验筛选并确认产ESBLs菌株。结果143株大肠埃希菌产AmpC酶、ESBLs及AmpC酶+ESBLs的总检出率分别为4.90%、28.67%、2.10%。非产酶株总耐药率,医院感染株为35.36%,社区感染株为21.85%,两者比较,差异有显著性(P<0.05);产酶株总耐药率两者分别为73.40%、75.60%,差异无显著性(P>0.05)。社区和医院感染的非产酶菌株对氨苄西林、哌拉西林、头孢唑林、环丙沙星等常用抗菌药物都有较高的耐药率,分别为57.58%、39.39%、42.42%、39.39%及77.97%、71.19%、66.10.%、54.24%;产酶菌株的耐药率均高于上述平均水平。所有被测药物中,亚胺培南/西司他丁敏感性最高,未出现耐药株。结论社区感染的大肠埃希菌非产酶株耐药率明显低于医院感染株。大肠埃希菌耐药的主要原因是产ESBLs和AmpC酶;亚胺培南/西司他丁为目前大肠埃希菌产酶株感染的临床经验首选用药。Objective To evaluate AmpC and extended-spectrum β-lactamases （ESBLs） produced by Escherichia coli from community and nosocomial infection and drug resistance to commonly used antimicrobial agents, so as to guide the rational use of antimicrobial agents. Methods AmpC was detected by cefoxitin three dimensional extraction test, ESBLs -producing strains were confirmed by double disc synergy and disc confirmatory test. Results The producing rate of AmpC, ESBLs and AmpC＋ ESBLs in 143 strains of Escherichia coli was 4. 90%, 28. 67% and 2. 10% respectively. Drug-resistant rate of non-enzyme-producing strains in nosocomial and community infection was 35. 36% and 21.85M respectively, there was significant difference between the two （P〈0. 05） ; drag-resistant rate of enzyme-producing strains in nosocomial and community infections was 73. 40% and 75.60% respectively,there was no significant difference between the two （P〉 0. 05）. Drug resistant rate of non-enzymes-producing strains in community and nosocomial infection to ampicillin, piperacillin, cefazolin and ciprofloxaein were all high, which was 57. 58%, 39. 39%, 42. 42%, 39. 39% and 77. 97%, 71.19%, 66. 10%, 54. 24% respectively; the resistant rates of enzymes-producing strains were higher than the above average resistant rate, among all detected antimierobial agents, imipenem/cilastatin was the most sensitive drug, there was no imipenem/ eilastatin-resistant strains. Condusion Enzyme-producing rate of Escherichia coli in community infection is obviously lower than that of nosocomial infection, AmpC and ESBLs are the main factors for drug resistance, imipenem/cilastatin is the first choice antimicrobial agents for the treatment of infection with enzyme-producing Escherichia coll.

关 键 词：大肠埃希菌AmpC酶 超广谱Β-内酰胺酶 抗药性 微生物 医院感染 社区感染 

分 类 号：R378.21[医药卫生—病原生物学]