产超广谱β-内酰胺酶变形杆菌的检测  

Detection of ESBLs-producing Proteus

作　　者：贾宁[1] 林茂虎[2] 陈世平[1] 索继江[1] 邢玉斌[1] 江朝光[1] 

机构地区：[1]解放军总医院,北京100853 [2]解放军第304医院,北京100037

出　　处：《中华医院感染学杂志》2003年第3期207-209,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目 (39970 6 2 9)

摘　　要：目的　了解变形杆菌对抗生素的敏感情况及评价产超广谱 β-内酰胺酶 (ESBL s)变形杆菌的检测方法 ,为临床合理使用抗生素和筛选产 ESBL s变形杆菌提出建议。方法　收集 1998年 8月～ 1999年 12月解放军总医院和 30 4医院临床分离的 4 5株变形杆菌 ,进行纸片扩散法、双纸片协同试验、Etest试验和纸片确认试验检测。结果　所有变形杆菌分离株对亚胺培南高度敏感 ,其次为头孢他啶、氨曲南和阿米卡星 (丁胺卡那霉素 ) ,对复方新诺明、环丙沙星和庆大霉素的敏感性低 ;双纸片协同试验、Etest试验和纸片确认试验 3种方法结果一致性好 ;头孢噻肟检测产 ESBL s变形杆菌的敏感性高于头孢他啶 (P<0 .0 5 )。结论　亚胺培南可为治疗产 ESBL s变形杆菌感染的首选方案 ;纸片扩散法初筛实验与 DDST结合判断方法敏感性和特异性高 ,且简单、易行、廉价 ,不失为临床广泛应用的有效方法 ;头孢噻肟检测产 ESBL s变形杆菌的敏感性高于头孢他啶 ,建议北京地区筛选产ESBL s变形杆菌时两种药物同时使用 ,以提高检出率。OBJECTIVE To investigate the antibiotic resistance of Proteus, evaluate the antimicrobial susceptibility testing methods, and give some suggestions for clinical antibiotic usage.METHODS Forty five clinical isolates were collected from Aug 1998 to Dec 1999 in General Hospital and the 304th hospital of PLA. They were all tested by disk diffusion method, double disk synergy test(DDST), Etest and confirmatory test of disk diffusion.RESULTS (1) All the isolates displayed high sensitivity to imipenem(IMP). The sensitivity to sulfamethoxazole co(SMZ co ), ciprofloxacin(CIP) and gentamicin(GEN) was low. (2) The testing results of three methods of DDST, Etest and confirmatory test of disk diffusion showed well consistent. (3) Cefotaxime(CTX) was a more sensitive indicator than ceftazidime(CAZ) in screening ESBLs producing Proteus (P<0.05). CONCLUSIONS (1) Imipenem can be used as the best drug for ESBLs producing Proteus infections. (2) The combination of disk diffusion method and double disk synergy test was a better method for its high sensitivity and specificity, low cost and easy to implement. (3) Cefotaxime was a more sensitive indicator than ceftazidime in screening ESBLs producing Proteus. It is suggested that using both drugs in screening ESBLs producing Proteus in Beijing city improve the detecting rate.

关 键 词：Β-内酰胺酶 变形杆菌 抗生素耐药性 

分 类 号：R378.99[医药卫生—病原生物学]