E试验对监护病房革兰氏阴性杆菌的耐药性研究  

Study on the resistance of Gram negative bacilli from ICU by E test

作　　者：盛家琦[1] 王其南[1] 蒋玉富[1] 陈海[1] 刘鸿渝[1] 郑行萍[1] 李崇智[1] 

机构地区：[1]重庆医科大学附属第一医院,重庆400016

出　　处：《中国抗生素杂志》2001年第6期451-453,467,共4页Chinese Journal of Antibiotics

摘　　要：目的　用 E试验法对我院监护病房分离的 2 0 0株革兰氏阴性杆进行 13种抗菌剂的体外敏感度测定 ,同时用经典的试管双倍稀释法作比较 ,以评价 E试验法在研究细菌耐药性方面的作用 ;进一步用头孢他啶 /克拉维酸检测对头孢他啶 MIC≥ 2 μg/ml的菌株中的超广谱 β-内酰胺酶 (ESBL)产生菌。结果　药物的抑菌率分别是 :亚胺培南 91% ,阿米卡星和头孢哌酮 /舒巴坦均为 82 % ,哌拉西林 /三唑巴坦 81% ,头孢他啶76 % ,头孢哌酮和哌拉西林各为 6 6 %和 6 8% ,头孢噻肟、头孢曲松和替卡西林 /克拉维酸均为 6 0 % ,庆大霉素和环丙沙星各为 5 7%和 5 8% ,头孢呋新 35 %。 E试验法和试管法的符合率为 78.9% ,但前者重复性更好。从80株对头孢他啶 MIC≥ 2 μg/ml的菌株中筛选出 ESBL 产生菌 9株 ,主要出现在大肠埃希氏菌中。结论　亚胺培南有较高抑菌率 ,且对 ESBL 产生菌有较好的抗菌活性 ;头孢哌酮和哌拉西林在分别加用 β-内酰胺酶抑制剂后抗菌活性均有所提高 ,表明酶抑制剂的应用亦是对付产酶耐药菌的策略之一。E试验法在研究细菌耐药性的方法中具有准确性高 ,重复性好 ,操作方便等优点 。Objective To study the resistance of 200 Gram negative bacilli from ICU, the E tests were performed to investigate the in vitro susceptibility of 13 antibiotics and compared with the liquid double dilution method. ESBL producing strains were selected by ceftazidime/clavulanic acid if MIC of ceftazidime was above 2μg/ml. Result The susceptibility rate to imipenem was 91%, and followed by amikacin and cefoperazone/sulbactam 82%; piperacillin/tazobatam 81%; ceftazidime 76%; piperacillin 68%; cefoperazone 66%; cefotaxime, ceftriaxone and ticarcillin/clavulanic acid 60%; ciprofloxacin 58%; gentamicin 57%; and to cefuroxime 35% respectively. Two methods had the matching rate of 78.9%, but E test had the better repeatability. 9 ESBL producing strains were selected mainly from Escherichia coli . Conclusion Imipenem had the highest antibacterial activity and was also effective to ESBL producing strains. Cefoperazone and piperacillin had better activities when β lactamase inhibitory agents were added. Because of good repeatability and more accuracy E test is worthy to use in clinical laboratory.

关 键 词：革兰氏阴性杆菌 细菌耐药性 E试验法 ESBL 抗菌剂 

分 类 号：R978.1[医药卫生—药品] R969.4[医药卫生—药学]