某院2011-2017年非痰标本产AmpC酶阴沟肠杆菌的临床分布及耐药性分析  

Analysis of Clinical Distribution and Drug Resistance of Non-sputum Specimen AmpC Enzyme-producing Enterobacter cloacae in a Hospital during 2011-2017

作　　者：谢朝云 熊芸 覃家露 孙静 杨怀[2] 杨忠玲 熊永发 XIE Chaoyun;XIONG Yun;QIN Jialu;SUN Jing;YANG Huai;YANG Zhongling;XIONG Yongfa(Dept.of Infection Management,the Third Affiliated Hospital of Guizhou Medical University,Guizhou Duyun 558000,China;Dept.of Infection Management,Guizhou Provincial People’s Hospital,Guiyang 550002,China;Dept.of Clinical Laboratory,the Third Affiliated Hospital of Guizhou Medical University,Guizhou Duyun 558000,China;Dept.of Orthopaedics,the Third Affiliated Hospital of Guizhou Medical University,Guizhou Duyun 558000,China)

机构地区：[1]贵州医科大学第三附属医院感染管理科,贵州都匀558000 [2]贵州省人民医院感染管理科,贵阳550002 [3]贵州医科大学第三附属医院检验科,贵州都匀558000 [4]贵州医科大学第三附属医院骨科,贵州都匀558000

出　　处：《中国药房》2018年第8期1069-1073,共5页China Pharmacy

基　　金：贵州省科技计划课题(黔科合LH字[2014]7162号);贵州省黔南州社会发展科技计划项目(黔南科合社字[2013]20号)

摘　　要：目的:为临床合理用药、医院感染控制提供参考。方法:收集2011年1月-2017年10月某院非痰标本中分离出的产头孢菌素酶(Amp C酶)阴沟肠杆菌,采用最低抑菌浓度法进行药敏试验,采用三维试验法确证产Amp C酶情况,采用双纸片协同扩散法检测产超广谱β-内酰胺酶(ESBLs)情况。结果:该院非痰标本中共分离出产Amp C酶阴沟肠杆菌546株,占非痰标本病原菌总数的4.80%(546/11 375),占阴沟肠杆菌总数的38.97%(546/1 401);检出率排序前3位的非痰标本依次为伤口分泌物(27.29%)、中段尿(25.82%)、血液(21.79%),检出率较高的科室依次为重症监护病房(ICU)(22.89%)、神经外科(18.68%)和普外科(16.67%)。产Amp C酶阴沟肠杆菌对大部分常用抗菌药物的耐药率>40%,其中不同年度该菌对头孢曲松、头孢噻肟、庆大霉素、呋喃妥因、左氧氟沙星、哌拉西林/他唑巴坦、头孢哌酮、头孢他啶、头孢吡肟、妥布霉素、米诺环素的耐药率比较,差异均有统计学意义(P<0.05);但对亚胺培南、美罗培南的耐药率<2%。546株产Amp C酶阴沟肠杆菌中,共检出产ESBLs菌株68株,其2011-2017年的检出率依次为5.77%、6.06%、8.70%、10.26%、13.79%、17.35%、18.75%。结论:该院产Amp C酶阴沟肠杆菌主要来自于伤口分泌物、中段尿等标本,且集中于ICU、神经外科等科室。该菌耐药情况严峻,对β-内酰胺类、喹诺酮类等抗菌药物的耐药率上升明显;产ESBLs菌株的检出率逐年上升;但对碳青霉烯类抗菌药物敏感,可将其作为经验首选药物。临床应加强产Amp C酶阴沟肠杆菌耐药及产酶情况的监测,并结合药敏试验结果合理选用抗菌药物,以阻止或延缓其耐药率的快速上升。OBJECTIVE:To provide reference for rational drug use and hospital infection control.METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan.2011-Oct.2017.Drug sensitivity test was conducted by using MIC.The situation of AmpC enzyme production was confirmed by three dimensional test,and that of ESBLs-producing stain was detected with double-disk synergy test.RESULTS:There were 546 strains of AmpC enzyme-producing E.cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80%of non-sputum specimen(546/11 375)and 38.97%of E.cloacae(546/1 401).Top 3 non-sputum samples in the list of detection rate were wound secretion(27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%),neurosurgery department(18.68%)and general surgery department(16.67%).Resistance rate of AmpC enzyme-producing E.cloacae to most commonly used antibiotics was higher than 40%.There was statistical significance in resistant rate of the bacteria to ceftriaxone,cefotaxime,gentamicin,nitrofurantoin,levofloxacin,piperacillin/tazobactam,cefoperazone,ceftazidime,cefepime,tobramycin and minocycline among different years(P<0.05).The resistant rate to imipenem and meropenem was lower than 2%.Among 546 strains of AmpC enzymeproducing E.cloacae,68 strains of ESBLs were detected,and detection rates were 5.77%,6.06%,8.70%,10.26%,13.79%,17.35%,18.75%during 2011-2017.CONCLUSIONS:AmpC enzyme-producing E.cloacae are mainly isolated from samples as wound secretion and midstream urine,and mainly come from ICU and neurosurgery department.The drug resistance of the bacteria is severe,and drug resistance of the bacteria to antibiotics asβ-lactams and quinolones is increased significantly.The detection rate of ESBLs-producing strain increases year by year.The bacteria are sensitive to carbapenems antibiotics,which can be regarded as first choice.It is necessary to strengthen drug resistance and enzyme production monitoring of AmpC enzyme-pro

关 键 词：非痰标本 阴沟肠杆菌 头孢菌素酶 超广谱Β-内酰胺酶 临床分布 耐药性 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]