胆汁中大肠埃希菌产超广谱β-内酰胺酶和头孢菌素酶的检测及耐药性分析  

Detection and drug resistance analysis of extended spectrum beta-lactamases and AmpC enzymes produced by Escherichia coli in bile

作　　者：严富国[1] 王灿灿 YAN Fu-guo;WANG Can-can(Department of Hepatobiliary Surgery,Xinchang County People's Hospital,Xinchang,Zhejiang 312500,China;不详)

机构地区：[1]新昌县人民医院肝胆外科,浙江新昌312500 [2]新昌县人民医院检验科,浙江新昌312500

出　　处：《中国卫生检验杂志》2020年第21期2595-2597,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的分析胆道感染患者胆汁中大肠埃希菌产ESBLs和Amp C酶及其耐药情况,为合理选用抗菌药物提供科学依据。方法对本院2016年3月-2019年3月胆道感染患者送检胆汁中分离的186株大肠埃希菌进行产ESBLs和Amp C酶的检测;按K-B纸片扩散法进行药敏实验。结果共检出产ESBLs和Amp C酶菌株104株,其中单产ESBLs59株(31.7%),单产Amp C酶25株(13.4%),ESBLs和Amp C酶均产20株(10.8%)。产酶株和非产酶株对亚胺培南、美罗培南、头孢哌酮/舒巴坦及头孢吡肟的耐药率较低,尤其是非产酶株;产酶株对常见抗菌药物的耐药率明显高于非产酶株,ESBLs和Amp C酶均产菌株的耐药性相当严重。结论引起本院胆道感染的大肠埃希菌主要是产生ESBLs和Amp C酶而对β-内酰胺类抗菌素耐药;对于一般胆道感染,可选用β-内酰胺酶抑制剂或头孢吡肟,对重症胆道感染,首选碳青霉烯类抗菌素治疗,但应根据药敏试验结果及时合理选用抗菌药物。Objective To study the detection and drug resistance analysis of extended spectrum beta-lactamases(ESBLs)and AmpC enzymes produced by Escherichia coli in bile of patients with biliary tract infection,so as to provide scientific basis for the reasonable use of antibiotics.Methods The ESBLs and AmpC enzyme production were detected in 186 strains of Escherichia coli isolated from the bile of patients with biliary tract infection in the hospital from March 2016 to March 2019.The drug sensitivity test was carried out by K-B disk diffusion method.Results A total of 104 strains of ESBLs and AmpC enzyme strains were detected,59 strains expressed ESBLs only,25 strains expressed AmpC enzyme only and 20 strains expressed both ESBLs and AmpC enzyme,accounting for 31.7%,13.4%,and 10.8%respectively;all strains showed lower drug resistance rates to imipenem,meropenem,cefoperazone/sulbactam and cefepime,especially for non-enzyme producing strains;the drug resistance rates of enzyme producing strains were significantly higher than that of non-enzyme producing strains to the most of commonly used antibacterial drugs;the strains that expressed both ESBLs and AmpC enzymes showed significant drug resistance.Conclusion Escherichia coli,which causes biliary tract infection in our hospital,mainly produces ESBLs and AmpC enzymes and is resistant to beta-lactam antibiotics;for general biliary tract infection,beta-lactamase inhibitors or cefepime can be selected.Carbapenems are preferred for treatment of severe biliary tract infection,but medical staff should choose timely and reasonably antibacterial drugs according to the results of drug sensitivity test.

关 键 词：胆道感染 大肠埃希菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]