ESBLs在大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌中的检出及耐药情况分析  

Comparison of detection and resistance rates of ESBLs among Escherichia coli,Klebsiella pneumonia and Enterobacter cloacae isolates

作　　者：张慧宇[1] 张博[1] 刘红丹[1] 徐文思[1] 宫健[1] 

机构地区：[1]齐齐哈尔医学院附属第三医院消化一科,黑龙江齐齐哈尔161000

出　　处：《中国病原生物学杂志》2013年第7期649-651,共3页Journal of Pathogen Biology

摘　　要：目的了解化脓性胆管炎患者胆汁培养中大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌中超广谱内酰胺酶(ES-BLs)检出及耐药情况。方法对2009年6月～2012年6月期间消化内科行ERCP检查及治疗的化脓性胆管炎患者的胆汁中培养出大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌,采用最低抑菌浓度法进行药敏测定,并采用双纸片协同试验进行确证试验。选用药敏纸片头孢噻肟、头孢噻肟/克拉维酸纸片,头孢他啶、头孢他啶/克拉维酸纸片。含克拉维酸和不含克拉维酸纸片间抑菌圈之差≥5mm即确认为产ESBLs株,同时进行药敏试验。结果 297株分离菌中,产ES-BLs菌株130株,检出率为43.77%;大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌分别为125、118和54株,产ESBLs分别为71、43和16株,检出率分布为56.80%、36.44%和29.63%。ESBLs肺炎克雷伯菌在胆总管结石患者的胆汁标本中的检出率最高,达93.02%;ESBLs大肠埃希菌在胆道恶性梗阻患者的胆汁标本检出率较高,为39.44%,产ESBLs菌对亚胺培南、美洛培南耐药率为0,对头孢类抗菌药物耐药率较高,产ESBLs阴沟肠杆菌对抗菌药物耐药率整体低于产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌。结论产ESBLs菌株是胆道感染的主要致病菌,了解其耐药机制,及时有效检测出其耐药性,有利于指导临床合理使用抗生素,延缓细菌耐药性的产生、控制耐药菌株的流行和暴发。Objective To understand the detection and drug resistance of ESBLs producing strains in Escherichia coli, Klebsiella pneumoiaeor and Enterobacter cloacae isolated from bile in suppurative cholangitis patients. Methods Mini- muminhibitory concentration was used to carry out experiments on E. coli, K. pneurnoiae, and E. cloacae isolated from bile in suppurative cholangitis patients who accepted ERCP examination and treatment in the department of gastroenterol- ogy from June 2009 to June 2012. And double disc synergy test was used as the confirmatory test. Susceptibility paper such as cefotaxime paper, cefotaxime / clavulanic acid paper, ceftazidime, ceftazidime / clavulanic acid paper was select- ed. Only when the difference of the zone of inhibition between the paper with clavulanic acid and the one without clavulan- ic acid should be above 5 mm, could it be recognized as the ESBLs producing strain. Then susceptibility test was carried out to detect drug resistance. Results 130 of 297 were ESBLs producing strains, with the detection rate of 43.77%. The number of strains in E. coli, K. pneurnoiae, and E. cloacae were 71, 43, 16 respectively, with the detection rate of 56.80%, 36.44% and 29.63%. The highest detection rate came from ESBLs producing Klebsiella pneumoniae in chole- docholithiasis patients, which was 93.02 %. Detection rate of ESBLs producing E. coli in malignant biliary obstruction pa- tients was 39.44%. ESBLs bacteria had no resistance to imipenem, meropenem and had high resistance rates to cephalo- sporins. Drug resistance rates of ESBLs producing E. cloacae were higher than those of ESBLs producing E. coli and K. pneurnoiae. Conclusion ESBLs strains are the main pathogens of biliary infection. To understand their mechanisms of resistance and detect its resistance in a timely and effective manner will help guide the rational use of antibiotics, and delay the occurrence of bacterial resistance to control drug-resistant strains epidemic and outbreak.

关 键 词：化脓性胆管炎 超广谱Β-内酰胺酶 检出率 耐药率 

分 类 号：R378.21[医药卫生—病原生物学] R378.14[医药卫生—基础医学]