产超广谱β-内酰胺酶大肠埃希菌的耐药性分析  

Drug resistance of extended-spectrumβ-lactamase-producing Escherichia coli

作　　者：王亚华[1] 祝永明[2] 邵平扬 吴晓燕 宋秀兰[4] 陈松劲 冯雪君 

机构地区：[1]嘉兴市第一医院药剂科,浙江嘉兴314001 [2]嘉兴市第二医院药剂科,浙江嘉兴314000 [3]嘉兴市第二医院检验科,浙江嘉兴314000 [4]嘉兴市第一医院检验科,浙江嘉兴314001

出　　处：《中华医院感染学杂志》2015年第6期1221-1223,共3页Chinese Journal of Nosocomiology

基　　金：浙江省重点科技创新团队基金资助项目(2010R50019)

摘　　要：目的：调查分析临床产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的耐药性，为临床合理使用抗菌药物和及早预防与控制医院感染提供科学依据。方法回顾性统计2012－2013年嘉兴地区两所综合性三甲医院中分离的产 ESBLs 大肠埃希菌资料，采用法国生物梅里埃公司 VETIK-2 Compact 全自动细菌鉴定仪和药敏卡进行细菌鉴定及耐药性分析。结果两年共检出大肠埃希菌4698株，其中2012年检出2236株、产 ESBLs 1254株，2013年 2 462株、产 ESBLs 1322株，产酶率分别为56．08％、53．70％；产 ESBLs 大肠埃希菌对氨苄西林、头孢唑林和头孢呋辛的耐药率＞95．00％，产 ESBLs 大肠埃希菌对头孢吡肟、头孢他啶、头孢曲松和氨曲南的耐药率均显著高于非产 ESBLs 大肠埃希菌；对亚胺培南、美罗培南和厄他培南的耐药率为0．23％～1．13％。结论产ESBLs 大肠埃希菌检出率较高且显示多药耐药性，治疗产 ESBLs 大肠埃希菌的感染可经验选用酶抑制剂复合制剂头孢哌酮／舒巴坦或哌拉西林／他唑巴坦，并可联合阿米卡星；重症感染可选用碳青霉烯类和替加环素。OBJECTIVE To investigate the drug resistance of clinical isolates of extended-spectrum β-lactamases （ESBLs）-producing Escherichia coli so as to provide scientific basis for reasonable clinical use of antibiotics and early prevention and control of nosocomial infections .METHODS The data of the ESBLs-producing E .coli that were isolated from two three-A hospitals of Jiaxing from 2012 to 2013 were retrospectively analyzed ,the bacterial identification was performed by using VETIK-2 Compact automatic bacterial identification system of bioMerieux , France ,and the drug resistance was analyzed with the use of drug susceptibility card .RESULTS A total of 4 698 strains of E .coli have been isolated in the two years ,including 2 236 strains in 2012 （1 254 ESBLs-producing strains） and 2 462 strains in 2013 （1 322 ESBLs-producing strains） ,with the rates of production of enzymes of 56 .08% and 53 .70% ,respectively .The drug resistance rates of the ESBLs-producing E .coli to ampicillin ,ce-fazolin ,and cefuroxime were more than 95 .00% ; the drug resistance rates of the ESBLs-producing E .coli to cefepime ,ceftazidime ,ceftriaxone ,and aztreonam were significantly higher than those of the non-ESBLs-produ-cing E .coli strains ;the drug resistance rates to imipenem ,meropenem ,and ertapenem ranged from 0 .23% to 1 .13% .CONCLUSION The detection rate of the ESBLs-producing E .coli is high ,and the strains are multidrug-re-sistant .The enzyme inhibitor compounds cefoperazone-sulbactam or piperacillin-tazobactam combined with amika-cin can be used for empirical treatment of the ESBLs-producing E .coli infections ;carbapenems and tigecycline can be used for the treatment of severe infections .

关 键 词：大肠埃希菌 产超广谱 Β-内酰胺酶 耐药性 

分 类 号：R378.21[医药卫生—病原生物学]