从大肠埃希菌和肺炎克雷伯菌中检测超广谱β内酰胺酶和AmpC酶  

Detection of extended spectrum β lactamases and AmpC enzyme from escherichia coli and klebsiella pneumoniae

作　　者：朱玉玫[1] 王煜[2] 

机构地区：[1]沈阳市第五人民医院,辽宁沈阳110023 [2]中国医科大学附属盛京医院急诊科

出　　处：《中国民康医学》2008年第10期966-967,1017,共3页Medical Journal of Chinese People’s Health

摘　　要：目的：研究大肠埃希菌和肺炎克雷伯菌的产酶及耐药模式，并对9种抗菌药做药敏试验，比较产酶菌与非产酶菌对9种抗菌药的耐药率，为临床治疗产酶菌感染提供理论依据。方法：菌株来源于2005年1月～2007年5月我院呼吸科住院患者送检合格痰标本中分离的大肠埃希菌43株、肺炎克雷伯菌67株。应用头孢西丁三维试验检测AmpC酶，采用美国国家临床实验室标准委员会（NCCLS）表型筛选和确认试验检测ESBLs菌株，以K-B琼脂扩散法做药敏试验。结果：在110株大肠埃希菌和肺炎克雷伯菌中，6株（5．45％）产AmpC酶，20株（18．2％）产ESBLs，1株（0．90％）同时产AmpC酶和ESBLs。大肠埃希菌和肺炎克雷伯菌中AmpC酶检出率分别为6．98％、5．97％，ESBLs检出率分别为16．3％、20．9％。产酶株对亚胺培南、头孢吡肟、阿米卡星耐药率低。结论：产AmpC酶和产ESBLs的大肠埃希菌和肺炎克雷伯菌为多重耐药菌株，治疗产2种B内酰胺酶细菌引起的感染亚胺培南为首选，头孢吡肟和阿米卡星可作为选用药物之一。Objective： To study the drug- resistance of enzymes - producing Escherichia coli and Klebsiella pneumoniae, compare the resistance rate of enzymes - producing strains and non - enzymes - producing strains to 9 antibiotics for the basis of treating infection caused by enzymes - producing strains.Methods： A total of 110 strains were isolated from the patients hospitalized in our respiratory ward during January 2005 - May 2007, 43 strains of them were Eseheriehia eoli, 67 strains of them were Klebsiella pneumoniae. A cefoxitin three - dimensional test and E - test were used to detect AmpC enzyme and extended spectrum 13 lactamases（ESBLs） respectively. Simultaneously, drug - susceptibility were meastured by disk diffusion method. Results： 6（5.45 % ） strains was AmpC positive, 22（ 18.2% ） strains was ESBLS positive and 1 （0.90%） strains AmpC ＋ ESBLs were found among 110 strains of Escherichia coli and Klebsiella pneumoniae. The resistance rate of enzymes - producing strains were low to imipenem, cepepime and amikacin. Conclusion： Producing AmpC and ESBLs Escherichia coli and Klebsiella pneumoniae were multidrugresistance strains. Imipenem was the most effective antibiotic for the treatment of infection caused by ESBLs or AmpC producing strains. Cepepime and amikacin were also effective for the treatment of such infections.

关 键 词：AMPC酶 超广谱酶β(ESBLs) 大肠埃希菌和肺炎克雷伯菌 药敏试验 

分 类 号：R378[医药卫生—病原生物学]