重症监护病房感染常见革兰阴性杆菌产AmpC酶、ESBLs及耐药性的研究  

AmpC Enzyme,ESBLs Production and Antibiotic Resistance in Gram-negative Bacilli Isolated in Intensive Care Unit

作　　者：邵良荣[1] 邵杰[2] 缪宇锋[1] 潘武华[1] 

机构地区：[1]东南大学医学院附属盐城医院检验科,江苏盐城224001 [2]南京中医药大学第一临床医学院,江苏南京210046

出　　处：《中华医院感染学杂志》2009年第1期1-3,共3页Chinese Journal of Nosocomiology

摘　　要：目的对重症监护病房(ICU)感染常见革兰阴性杆菌产AmpC酶、超广谱β-内酰胺酶(ESBLs)及耐药性进行分析,为临床合理用药提供依据。方法全部细菌用VITEK-32系统进行鉴定和药敏试验,行药敏纸片法。结果184株革兰阴性(G-)杆菌前5位依次为铜绿假单胞菌、鲍氏不动杆菌、阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌分别占43株(24.4%)、34株(19.3%)、26株(14.8%)、18株(10.2%)、17株(9.7%);产ESBLs株的检出率以肺炎克雷伯菌、大肠埃希菌为高,分别为:肺炎克雷伯菌58.8%、大肠埃希菌50.0%,产AmpC酶以阴沟肠杆菌为高(53.8%),其次为鲍氏不动杆菌(14.7%),产AmpC酶+ESBLs株的检出率以鲍氏不动杆菌、阴沟肠杆菌为高,分别为:鲍氏不动杆菌(35.3%)、阴沟肠杆菌(15.4%),铜绿假单胞菌菌株对亚胺培南均保持着较高敏感率,其中肺炎克雷伯菌的耐药率为0。结论ESBLs和AmpC酶是G-杆菌产生耐药的重要机制。OBJECTIVE To investigate the production of AmpC enzyme and ESBLs in Gram-negative bacilli and their drug-resistance to provide basis for reasonable use of antibiotics in clinical practice. METHODS All bacteria were identified by VITEK-32 system and disk test. RESULTS The main five strains of all 184 Gram-negative bacilli were Pseudomonas aeruginosa （24. 4%）, Acinetobacter baumannii （ 19. 3%）, Enterobacter cloacae （14.80//oo）, Escherichia coli （10.2%） and Klebsiella pneumoniae （9.7%）. The AmpC enzyme-producing rate was 53.8% and 14.7% in E. cloacae and A. baumannii the ESBLs-producing rate was 35. 3% （12/34） and 15.4% （4/26） in A. baurnannii and E. cloacae. P. aeruginosa was sensitive to imipenem and the drug-resistance rate of K. pneumoniae was 0%. CONCLUSIONS ESBLs and AmpC enzymes are important mechanisms of the drugresistance of Gram-negative bacilli.

关 键 词：重症监护病房 革兰阴性杆菌 超广谱Β-内酰胺酶 耐药性 

分 类 号：R378[医药卫生—病原生物学]