临床不同标本及不同科室的大肠埃希菌耐药性分析  

Analysis of drug resistance of Escherichia coli in different clinical specimens and different departments

作　　者：展冠军[1] 朱国龙[1] 戴真南[1] 陆瑾[1] Zhan Guan-jun;Zhu Guo-long;Dai Zhen-nan;Lu Jin(Zhongda Hospital Affiliated to Southeast University, Nanjing 210009)

机构地区：[1]东南大学附属中大医院,南京210009

出　　处：《中国抗生素杂志》2018年第6期734-738,共5页Chinese Journal of Antibiotics

基　　金：南京市药学会项目(No.2016YX009)

摘　　要：目的通过分析我院临床不同送检标本及不同科室检出的大肠埃希菌(E.coli)的耐药情况,为临床科室对大肠埃希菌的感染进行有效控制及治疗提供依据。方法分离我院2012年1月—2016年12月临床不同送检标本的大肠埃希菌,采用Vitek-2 Compact全自动微生物分析仪进行细菌鉴定及药物敏感性试验。结果临床送检的各类标本共检出大肠埃希菌2241株,前4位标本来源分别为尿液1018株(45.4%)、分泌物479株(21.4%)、血液387株(17.3%)和痰液290株(12.9%)。泌尿外科分离率最高占14.9%,其次为ICU占13.3%,呼吸内科占13.1%。检出的大肠埃希菌中,耐药率高的标本主要是尿液、痰和分泌物,耐药率高的科室主要是泌尿外科、ICU及呼吸内科,耐药率高的药物主要以哌拉西林、头孢唑林、头孢噻肟、头孢曲松、左氧氟沙星、氨苄西林、氨苄西林/舒巴坦及环丙沙星为主。不同标本及不同科室抗菌药物中头孢他啶、头孢吡肟、头孢曲松、头孢替坦、左氧氟沙星、氨曲南、氨苄西林和氨苄西林/舒巴坦的耐药率差异均有统计学意义(P<0.05)。结论通过对不同标本及不同科室菌株检出的大肠埃希菌的耐药情况进行分析,可以更准确反映菌株的耐药性状况,更好地指导临床合理使用抗菌药物,减少或延缓耐药菌株的产生。本研究的结果表明:临床医生在结合不同标本、不同科室间耐药率差异的同时,对于我院感染大肠埃希菌的患者经验用药可首选头孢哌酮/舒巴坦与头孢西丁。Objective To provide the basis for effective control and treatment of the infections of Escherichia coli （E.coli） in clinical departments, the drug resistance ofE. coli detected in different clinical specimens and different departments in our hospital were analyzed. Methods E. coli from different clinical specimens in our hospital during 2012.01-2016.12 were isolated. The Vitek-2 Compact automatic microbiological analyzer was used for bacterial identification and drug sensitivity test. Results There were a total of 2,241 strains ofE. coli separated from different specimens. 1,018 strains （45.4%）, 479 strains （21.4%）, 387 strains （17.3%）, and 290 strains （12.9%） were in urine, secretions, blood, and sputum, respectively. The separation rate in the department of urology was the highest （14.9%）. The second and third were ICU （13.3%） and respiratory medicine （13.1%）, respectively. The high resistance rate of the specimens in E. coli were mainly detected in urine, sputum, and secretions. High rates of resistance were detected in departments of urology, ICU, and respiratory. Highly resistant E. coli were mainly resistant to piperacillin, cefazolin, cefotaxime, ceftriaxone, levofloxacin, ampicillin, ampicillin/sulbactam, and ciprofloxacin-based drugs. The resistance rates of ceftazidime, cefepime, ceftriaxone, cefotetan, levofloxacin, aztreonam, ampicillin, and ampicillin/sulbactamin different specimens and different departments were statistically significant different （P〈0.05）. Conclusion It can more accurately reflect the drug resistance status of the strain, better guide the rational use of antimicrobial agents in clinical, and reduce or delay the drug-resistant strains through the analysis of the resistance status of E. coli detected in different specimens and different strains. The results of the study show that clinicians can choose cefoperazone/ sulbactam and cefoxitin as the experience drugs in combination with the analysis of different specimens and different rates of resis

关 键 词：大肠埃希菌 耐药性 临床标本 临床科室 

分 类 号：R978.1[医药卫生—药品]