大肠埃希菌产超广谱β-内酰胺酶的耐药性分析  

Analysis of drug resistance of extended spectrumβ-lactamases-produced by Escherichia coli

作　　者：郭琼杰[1] 杨柳[1] 杨晨[2] 王娜[1] 王珊珊[1] Guo Qiongjie;Yang Liu;Yang Chen(Department of Pharmacy,Qinhuangdao First Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院药学部,066000 [2]天津医科大学总医院药剂科

出　　处：《中华保健医学杂志》2021年第2期142-145,共4页Chinese Journal of Health Care and Medicine

基　　金：河北省医学科学研究课题计划项目(20191389)。

摘　　要：目的分析大肠埃希菌(Escherichia coli,E.coli)产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)的耐药性。方法选取2017年6月~2019年6月秦皇岛市第一医院收治的非重复大肠埃希菌感染80例患者作为研究对象,分别对其感染标本中的细菌进行检验、分离培养,运用常规鉴定技术鉴定细菌并进行药敏试验,使用纸片扩散法(K-B paper diffusion method,K-B法)检测E.coli,使用K-B法和国家临床实验室标准委员会(national committee for clinical laboratory standards,NCCLS)建议的双纸片协同试验进行ESBLs检测,统计E.coli ESBLs阳性株数并分析其耐药性。结果非重复大肠埃希菌感染病例80例患者中E.coli ESBLs阳性株23株,占比28.75%,阴性株57例,占比71.25%。E.coli ESBLs阳性株主要来源于尿液标本,之后依次为穿刺液、痰液、血液及引流液。对E.coli ESBLs阳性株进行耐药性分析,结果显示亚胺培南的体外活性最好,耐药率最低为0.00%,其次为阿米卡星4.35%、头孢替坦4.35%、厄他培南4.35%、左氧氟沙星4.35%、头孢他啶4.35%、哌拉西林/他唑巴坦4.35%、妥布霉素4.35%;该试验中细菌对复方新诺明的耐药性最高为95.65%,其次为阿莫西林/克拉维酸91.30%、氨苄西林91.30%、氨曲南86.96%、头孢曲松86.96%。结论E.coli ESBLs对复方新诺明、阿莫西林/克拉维酸、氨苄西林、氨曲南、头孢曲松有着较强的耐药性,对亚胺培南、阿米卡星、头孢替坦、厄他培南、左氧氟沙星、头孢他啶、哌拉西林/他唑巴坦、妥布霉素等药物较为敏感,临床治疗时应严格根据细菌分布特点结合其耐药情况进行合理给药。Objective To investigate the drug resistance of extended spectrumβ-lactamases(ESBLs)produced by Escherichia coli(E.coli).Methods Randomly selected 80 patients with non repetitive Escherichia coli infection in our hospital from June 2017 to June 2019 as the research object.The bacteria in their infected specimens were tested,isolated and cultured.The bacteria were identified by conventional identification technique and the drug sensitivity test was performed.The disk diffusion method was used to detect E.coli,the double-disk synergy test recommended by National Committee for Clinical Laboratory Standards and the K-B paper diffusion method were used to detect ESBLs,and the distribution characteristics and drug resistance of bacterial infection were analyzed.Results A total of 80 strains of E.coli ESBLs were isolated from infected patients,of which 23 strains of ESBLs were positive,accounting for 28.75%,and 57 strains of ESBLs were negative,accounting for 71.25%;E.coli ESBLs positive strains were mainly from urine samples,followed by puncture fluid,sputum,blood and drainage fluid.After drug resistance analysis of E.coli ESBLs positive strains,the results showed that Imipenem had the best activity in vitro with the lowest resistance rate of 0.00%,followed by Amikacin 4.35%,Cefotetan 4.35%,Ertapenem 4.35%,Levofloxacin 4.35%,Ceftazidime 4.35%,Piperacillin/Tazobactam 4.35%,Tobramycin 4.35%.What's more,Cotrimoxazole had the highest resistance with the resistance rate of 95.65%,followed by Amoxicillin/Clavulanic Acid 91.30%,Ampicillin 91.30%,Aztreonam 86.96%,Ceftriaxone 86.96%.Conclusion E.coli ESBLs showed strong resistance to Cotrimoxazole,Amoxicillin/Clavulanic Acid,Ampicillin,Aztreonam and Ceftriaxone,and it is sensitive to Imipenem,Amikacin,Cefotetan,Ertapenem,Levofloxacin,Ceftazidime,Piperacillin/Tazobactam and Tobramycin.Clinical antibacterial treatment should be strictly based on the distribution characteristics of bacteria,combined with their drug resistance.

关 键 词：大肠埃希菌 产超广谱Β-内酰胺酶 耐药性分析 药敏试验 

分 类 号：R378.2[医药卫生—病原生物学]