2014—2015年临床分离737株大肠埃希菌的耐药性分析  

Analysis of Drug Resistance of 737 Strains of Escherichia coli Isolated From 2014 to 2015

作　　者：罗名媛 赵德军 胡昭宇[1] 曹雁[1] 武静[1] 王发丽[1] 

机构地区：[1]解放军第44医院,贵阳550009 [2]清镇市第一人民医院,清镇551400

出　　处：《国外医药（抗生素分册）》2017年第4期I0012-I0015,共4页World Notes on Antibiotics

摘　　要：目的对解放军第44医院2014年1月—2015年12月临床标本中大肠埃希菌的感染情况及耐药性进行分析,为临床合理用药提供依据。方法对患者送检的各种临床标本进行分离培养,通过法国梅里埃Vitek-2 compact细菌鉴定分析仪及配套的GN鉴定卡、GN 13、ATB G-5药敏卡进行病原菌的鉴定和药敏试验。结果共分离出病原菌4439株,其中大肠埃希菌有737株,占16.6%。大肠埃希菌感染的标本来源以尿液、痰液及伤口分泌物多见,分别占51.8%、20.8%和17.8%;感染的病区主要集中在泌尿科、骨外科、老年病科和ICU。药敏结果显示大肠埃希菌对阿莫西林、氨苄西林的耐药率>85.0%,对头孢唑啉、头孢噻肟、复方磺胺甲噁唑、头孢曲松、环丙沙星的耐药率>60.0%,对左氧氟沙星、氨苄西林/舒巴坦、头孢他啶、头孢吡肟、氨曲南、庆大霉素、阿莫西林/克拉维酸、妥布霉素、呋喃妥因等耐药率在17.9%~58.7%之间,对呋喃妥因、头孢替坦、哌拉西林/三唑巴坦、阿米卡星的耐药率<10.0%,对亚胺培南、厄他培南的耐药率<1.0%。结论大肠埃希菌对临床常用抗菌药物出现了不同程度的耐药性,碳青霉烯类药物(亚胺培南、厄他培南)是重症感染的首选抗菌药物。临床应不断提高标本培养的送检率并加强细菌耐药性的监测工作,以促进抗菌药物的合理使用。Objective To analyze the infection and drug resistance of Escherichia coli in clinical specimens from January 2014 to December 2015, and to provide the basis for clinical rational drug use. Methods Various clinical specimens were isolated and cultured. The pathogen identification and drug susceptibility test were carried out with the BioMerieux Vitek-2 Compact Bacterial Identification Analyzer and the supporting GN identification Card, GN 13, ATB G-5 drug sensitive card. Results 4439 strains of pathogens were isolated, among which 737 were Escherichia coli, accounting for 16.6%. The specimen sources of Escherichia coli infection were more common in urine, sputum and wound secretions, accounting for 51.8%, 20.8% and 17.8%; infected ward mainly concentrated in urology, bone surgery, geriatrics and ICU. The antimicrobial susceptibility of Escherichia coli to amoxicillin and ampicillin were higher than 85.0%, and the resistance rate to cefazolin, cefotaxime, cotrimoxazole, ceftriaxone and ciprofloxacin were higher than 60.0%. The resistance rate to levofloxacin, ampicillin/sulbactam, ceftazidime, cefepime, aztreonam, gentamicin, amoxieillin/clavulanic acid, tobramycin, nitrofurantoin were between 17.9-58.7%, and resistance to nitrofurantoin, cefotetan, piperacillin/tazobactam and amikacin were less than 10.0%, and the resistance rate to imipenem and etorapenem were less than 1.0%. Conclusion Escherichia coli has a different degree of drug resistance in clinical antimicrobial agents. Carbapenem drugs （imipenem, etopatinone） are the first choice of antimicrobial agents for severe infection. In clinical practice, we should continue to improve the test rate of specimen culture and strengthen the monitoring of bacterial resistance to promote the rational use of antimicrobial agents.

关 键 词：大肠埃希菌 抗菌药物 耐药性 

分 类 号：R446.5[医药卫生—诊断学]