儿科产超广谱β内酰胺酶大肠埃希菌耐药的流行特征分析  

Prevalence of extended-spectrum beta-lactamase producing Escherichia coli in pediatric patients in China

作　　者：王丽[1] 杨永弘[1] 陆权[2] 王艺[3] 陈沅[4] 邓力[5] 邓秋莲[5] 张泓[2] 王传清[3] 刘岚[4] 徐樨巍[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院儿研所微生物室,100045 [2]上海交通大学附属上海市儿童医院检验科 [3]复旦大学附属儿科医院检验科 [4]重庆医科大学附属儿童医院检验科 [5]广州市儿童医院检验科

出　　处：《中华医学杂志》2008年第20期1372-1375,共4页National Medical Journal of China

基　　金：国家科技部“十五”攻关课题基金资助项目（2004BA720A09-01）志谢 北京儿童医院细菌室甄景慧、董芳、吕萍老师提供质控菌株及在细菌培养分离技术上给予的指导与帮助;北京儿童医院儿研所微生物室俞桑结、袁林、姚开虎老师在实验技术上的指导与帮助

摘　　要：目的研究我国4个地区儿科产超广谱β内酰胺酶（ESBL）大肠埃希菌的耐药流行特征，为临床儿科其致病菌感染治疗提供参考。方法2005-2006年4个地区5家儿童专科医院临床分离大肠埃希菌5127株，酶抑制剂增强试验初筛及确证产ESBL，琼脂稀释法测定349株产ESBL大肠埃希菌对9种儿科常用抗生素最小抑菌浓度（MIC）。结果判断标准根据美国临床标准化委员会2005年版执行。结果5127株大肠埃希菌产ESBL率为46．7％。349株产ESBL大肠埃希菌对阿莫西彬克拉维酸耐药率为23．1％，中介率为38．5％；头孢噻肟、头孢他啶、头孢吡肟耐药率分别为67．2％、24．5％和48．4％，中介率分别为26．4％、5．7％和19．1％；阿米卡星耐药率为5．4％，未检出亚胺培南耐药株。分离株对阿莫西林／克拉维酸、头孢吡肟、环丙沙星及庆大霉素耐药性存在地区差异。结论ESBL在中国儿科临床分离大肠埃希菌中广泛流行，除亚胺培南、阿米卡星外，产ESBL大肠埃希菌对β内酰胺类药物耐药现象严重，部分药物耐药性存在地区差异。Objective To study the drug resistance profiles of extended spectrum beta lactamase （ESBL） producing Escherichia coli （E. coli） and provide guidance for pediatric clinical prescription. Methods 5127 strains of ESBL producing E. coli were isolated from 5 children＇s hospitals in Beijing, Shanghai, Chongqing, and Guangzhou. The minimum inhibitory concentration （MIC） values of 349 strains to 9 antibiotics most in use in pediatrics were measured with agar dilution method. Results The prevalent rate of ESBL producing of E. coli was 46.7%. The resistant rates to ampicllin/clavulanic acid, cefotaxime, ceftazidime, and cefepime were 23.1%, 67.2%, 24.5%, and 48.4% respectively, and the intermediate rates were 38.5%, 26.4%, 5.7%, and 19. 1% respectively. The resistant rate to amikacin was 5.4%. All the strains were susceptive to imipenem. The MIC90 values of ampicillin, cefotaxime, cefepime, ciprofloxacin, and gentamicin were 256 mg/L or higher. There were differences in the resistance profile to ampicllin/clavulanic acid, cefepime, ciprofloxacin, and gentamicin among different regions. Conclusion ESBL is extensively prevalent among the E. coli strains isolated from the pediatric clinic that are resistant to most antimicrobial agents except imipenem and amikacin. Regional difference exists in drug resistance to some agents exist.

关 键 词：抗药性 微生物 微生物敏感性试验 抗药性 多药 抗菌药 

分 类 号：R686[医药卫生—骨科学]