187株奇异变形杆菌的分布及耐药特征分析  

Distribution and drug resistance of extended-spectrum β-lactamases and Cephalosporinases-producing in 187 strains of Proteus mirabilis

作　　者：王晓丽[1] 孙倩楠 马秀敏 WANG Xiaoli;SUN Qiannan;MA Xiumin(The Second Hospital Affiliated of Xinjiang Medical University, Urumqi, Xinjiang, 830028, China;The First Hospital Atfrliated of Xinjiang Medical University, Urumqi, Xinjiang, 830054, Chin)

机构地区：[1]新疆医科大学第二附属医院检验科,乌鲁木齐830028 [2]新疆医科大学第一附属医院检验科,乌鲁木齐830054

出　　处：《新疆医学》2018年第3期269-274,共6页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金项目(2016D01C195)

摘　　要：目的了解我院2011年1月-2016年12月奇异变形杆菌产超广谱β-内酰胺酶(ESBLs)和头孢菌素(Amp C)酶在感染中的分布及耐药特征,为临床合理使用抗生素提供依据。方法细菌鉴定采用法国生物梅里埃公司VITEK2-compact的GN鉴定卡;药敏试验采用K-B扩散法;双纸片增效法检测ESBLs;头孢西丁三维实验法检测Amp C酶;应用Whonet5.6、SPSS13.0软件进行统计分析。结果六年中分离出187株奇异变形杆菌,主要来自呼吸道痰及尿液,分别占39.04%及36.90%,其中老年病科检出45株最多,占24.06%,其次是康复科36株,占19.25%。共检出产酶菌62株,占33.16%,以单产ESBLs38株为主,占20.32%、其次是同时产ESBLs+Amp C酶13株及单产Amp C酶11株,分别占6.95%及5.88%,其中ICU产酶检出率最高,占47.83%。2013年-2016年分离株及产酶检出率与2011年~2012年相比,有显著性差异(P<0.01)。年龄越大奇异变形杆菌分离率及产酶率也就越高。产酶株与非产酶株对相同抗生素的耐药率相比较,均存在显著性差异(P<0.01)。同产ESBLs+Amp C酶株对亚胺培南耐药率较高,占61.54%。单产Amp C酶的奇异变形杆菌除外头孢唑啉、头孢呋辛、头孢吡肟、厄他培南、美罗培南、哌拉西林/他唑巴坦、左氧氟沙星、环丙沙星等,余者16种抗生素耐药率相比于单产ESBLs更高。而同产ESBLs+Amp C酶的奇异变形杆菌除外氨苄西林、头孢唑啉、头孢呋辛、头孢噻肟、头孢哌酮、头孢曲松、氨苄西林/舒巴坦等,余者17种抗生素与单产Amp C酶和单产ESBLs相比,耐药率更高且更广泛。总耐药率数据显示:哌拉西林/他唑巴坦、厄他培南、美罗培南、头孢吡肟、亚胺培南、阿米卡星及头孢哌酮/舒巴坦都可作为治疗奇异变形杆菌感染的首选药。结论产酶的奇异变形杆菌耐药严重,合理使用抗生素以减少耐药率。Objective To investigate the distribution and antibiotic resistance of extended-spectrum β-lactamases（ESBLs）and eephalesporin（AmpC）enzymes produced by Proteus mirabilis in our hospital from January 2011 to December 2016,and to provide the drug use for clinical practice.Methods The identification of bacteria was carried out using the VITEK2-compact GN identification card from France BioM 6 rieux Company.The drug susceptibility test was performed with KB diffusion method and ESBLs with double disk synergistic method.AmpC enzyme was detected by Cefoxitin three-dimensional method.Whonet5.6,SPSS13.0 software was used for statistical analysis.Results 187 strains of Proteus mirabilis were isolated from respiratory tract sputum and urine,accounting for 39.04% and 36.90% respectively.Among them,45 strains were found in geriatrics department,accounting for 24.06%,followed by 36 cases in rehabilitation department which accounted for 19.25%.62 predueing enzyme strains was found,and they accounted for 33.16%,among which the main strains were 38 strains of ESBLs accounting for 20.32%.The followed strains were 13 strains of ESBLs ＋ AmpC and 11 strains of AmpC,accounting for 6.95% and 5.88% respectively.The detection rate of enzyme production in ICU was the highest,accounting for 47.83%.The detection rate of isolates and enzyme production from 2013 to 2016 was significantly different from those of 2011 to 2012（P 〈0.01）.The higher of separation rate and the rate of enzyme production of Proteus mirabilis were,the older people were.There were significant differences in the esistance to the same antibiotics between the enzymes-producing strains and the non-enzymes-producing strains（P 〈0.01）.The resistance rate of imipenem was higher than ESBLs ＋ AmpC,accounting for 61.54%.The drug resistance rate of the AmpC-producing Proteus mirabilis strains was higher than that of the ESBLs-producing strains to the 16 kinds of antibiotics except for 8 kinds of antibiotics including cefazoline,cefuroxime,eefepime,ertapenem

关 键 词：奇异变形杆菌 ESBLS AMPC 耐药性 

分 类 号：R3[医药卫生—基础医学]