近5年杭州地区肝病患者产ESBLs大肠杆菌连续性耐药分析  

Dynamic Observation and Analysis of Antibiotic Resistance of ESBLs-producing Escherichia Coli Isolated from Hepatopathy Patients in Hang Zhou Area During the Last 5 Years

作　　者：周俊[1] 宋超[2] 朱明利[1] 厉小玉[1] 章松平[1] 

机构地区：[1]杭州市第六人民医院开放实验室,310014 [2]浙江省临床检验中心

出　　处：《医学研究杂志》2011年第9期123-125,共3页Journal of Medical Research

摘　　要：目的动态观察分析5年杭州地区肝病患者感染产超广谱β-内酰胺酶(ESBLs)大肠杆菌的检出率及耐药性变化,并了解地区总体情况,为临床抗菌治疗提供依据。方法选取从2005年1月～2009年12月入院肝病患者中分离出的非肠道致病性大肠杆菌729株,采用美国临床实验室标准化委员会(NCCLS/CLSI)推荐的纸片扩散确证法进行检测,应用WHONET5.3软件对药敏试验进行统计,对产ESBLs菌和非产ESBLs菌的药敏试验数据进行对比分析,并对产ESBLs菌的检出率、耐药率以及与杭州综合性医院差异性等方面进行分析。结果 5年来杭州地区肝病患者分离出的非肠道致病性大肠杆菌中ESBLs阳性率分别为12.0%、22.0%、21.8%、22.9%和30.3%,呈逐渐上升趋势,但总体低于杭州医院平均水平。除亚胺培南外,产ESBLs菌对抗菌药物的耐药率明显高于非产ESBLs菌,大肠杆菌的耐药率与杭州地区总体情况基本一致。结论肝病患者中大肠杆菌产ESBLs菌的检出率呈逐年上升趋势。亚胺培南、头孢西丁、阿米卡星、哌拉西林/他唑巴坦对肝病患者的产ESBLs大肠杆菌有相对较好的抗菌活性,同时在选用抗菌药物时,除考虑肝功能外,目前对肝病患者可暂不做区别对待。Objective To investigate and analyze the isolation rate and antibiotic resistance rate of extended spectrum beta - lacta- mases （ESBLs） -producing Escherichia coli from hepatopathy patients from 2005 to 2009 and to provide proposals to clinical treatment. Methods 729 ESBLs - producing Escherichia coli strains from hepatopathy patients were detected by the method recommended by Nation- al Committee for Clinical Laboratory Standards or Clinical and Laboratory Standards Institute （NCCLS/CLSI）. The antibiotic susceptibility was tested by the Kirby - Bauer method and the data were analyzed by the software of WHONET5.3. The antibiotic susceptibility test data in either ESBLs - producing or non - producing strains were analyzed comparatively. The isolation rate, antibiotic resistance rate and the differences from other hospitals in the same areas were all analyzed deeply. Results Of 729 strains of Escherichia coli, 169 strains were positive ,with the rate of 12.0% ,22.0% ,21.8% ,22.9% and 30.3% year by year,and the elevating mode by years was shown. The anti- biotic susceptibility tests in vitro showed that imipenem, cefoxitin, amikacin and piperacillin - tazobactam were effective to ESBLs - produ- cing Escherichia coli. The ESBLs - producing Escherichia coli displayed the multi - antibiotic resistance, and the drug resistance rate in ES- BLs - producing strains was higher than that in non - producing strains. Conclusion The positive rate of ESBLs - producing Escherichia coli increased year by year in hepatopathy patients during the last five years. Imipenem, cefoxitin, amikacin and piperacillin/tazobactam are suitable for clinical treatment of infection caused by ESBLs - producing Escherichia coli. It is necessary to increase the laboratory detection rates to avoid the drug abuses. The antibiotic drugs used in clinical treatments to hepatopathy patients can be the same as other patients.

关 键 词：肝病 大肠杆菌 ESBLS 耐药性 

分 类 号：R978.11[医药卫生—药品]