2007-2009年大肠埃希菌产ESBLs株分离率及对碳青霉烯类药物的耐药性变迁  

Isolated rate of ESBLs-producing Escherichia coli from 2007 to 2009 and variation of carbapenems resistance

作　　者：胡丽庆[1] 吕火祥[2] 孙定河[1] 史煜波[1] 史颖娇[1] 黄志刚[1] 

机构地区：[1]宁波市第一医院检验科,浙江宁波315000 [2]浙江省人民医院检验医学中心,浙江杭州310014

出　　处：《中华医院感染学杂志》2011年第15期3258-3260,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析2007-2009年宁波地区产ESBLs大肠埃希菌的检出率,以及对亚胺培南和美罗培南两种碳青霉烯类药物的耐药性和变迁,指导临床合理使用抗菌药物,控制医院感染。方法统计分析3年大肠埃希菌的临床分布及产ESBLs菌株的分离情况,采用M-H琼脂稀释法测定亚胺培南和美罗培南对细菌的最低抑菌浓度(MIC),了解其变迁趋势。结果 2007-2009年大肠埃希菌分离率无明显变化,3年呼吸科最高,占30.2%,其次ICU,占26.4%,急诊科占23.6%;产ESBLs菌株分离率,2007年36.7%;2008年44.6%;2009年56.9%;对亚胺培南的耐药率从2007年的0.2%升至2009年的1.2%,对美罗培南的耐药率从2007年的0升至2009年的0.9%;3年中该菌对这两种碳青霉烯类药物的累积MIC值均连续往高值漂移。结论大肠埃希菌在医院的分布主要集中在呼吸科、ICU及急诊科;产ESBLs菌株分离率逐年增加;对碳青霉烯类抗菌药物的耐药率逐年增加,其累积MIC值向高值漂移明显;将耐药监测和临床抗菌药物的合理应用有机结合,在延缓细菌耐药性的产生方面具有十分重要的意义。OBJECTIVE To investigate the isolated rate of ESBLs-producing and the Carbapenems resistance of Escherichia coli in order to provide reference for the clinical application of drugs and to control the nosocomial infection.METHODS The distribution and isolated rate of ESBLs-producing of E.coli during three years from 2007 to 2009 were analyzed.The change in the carbapenems resistance of E.coli and the minimum inhibitory concentration（MIC） of imipenem and meropenem of E.coli were determined by the M-H agar dilution method,then the variation of carbapenems resistance was observed.RESULTS Among the three years,no change was found in the isolated rate of E.coli in clinic.The highest isolated rate was in the respiratory ward（30.2%）,the second was in ICU（26.4%）,and the third was in the emergency ward（23.6%）.The ESBLs-producing rate of E.coli was 36.7% in 2007,44.6% in 2008,56.9% in 2009.The resistance rate of imipenem was increasing from 0.2% in 2007 to 1.2% in 2009,and from zero in 2007 to 0.9% in 2009 for meropenem.The MIC value of imipenem and meropenem were trend to higher one all.CONCLUSION The distribution of E.coli focuses in mainly the respiratory ward,ICU and the emergency ward.The ESBLs-producers are increasing year and year.The carbapenems resistance of E.coli is more and more serious.It should be cautious to use cephalosporins to treat infections caused by E.coli.It is very important to select rational drugs correctly for clinical treatment of the infections according to the results of antibiotics susceptibility tests.

关 键 词：大肠埃希菌 碳青霉烯类 超广谱β-内酰胺酶 耐药率 最低抑菌浓度 

分 类 号：R378.21[医药卫生—病原生物学]