临床上持续高产Ampc酶和ESBLs酶的细菌耐药性研究  

Study of Antibiotic Resistance in Strains Continuously Producing High AmpcβLactamase and ESBLs

作　　者：王海英[1] 左芸[2] 王新锋[2] 蒋彩华[2] 

机构地区：[1]山东大学,山东济南250012 [2]山东省胸科医院,山东济南250013

出　　处：《中国误诊学杂志》2003年第1期7-9,共3页Chinese Journal of Misdiagnostics

摘　　要：目的　研究济南地区临床上持续高产 Ampc酶及 ESBL s酶的细菌对 18种抗生素的耐药性情况以及在我院的流行情况。方法　头孢西丁三维试验检测持续高产 Ampc酶的菌株 ,纸片扩散法 (筛选试验、确认试验 )检测产 ES-BL s的菌株 ,抗生素敏感试验采用纸片扩散法按美国临床实验室标准化委员会 (NCCL S)推荐标准实施。结果　 139株细菌检出持续高产 Ampc酶的菌株共 2 1株 ,阳性率为 15 .11% ,检出产 ESBL s酶的菌株共 4 1株 ,阳性率为 2 9.5 0 % .2 1株持续高产 Ampc酶的菌株 ,除对亚胺培南、头孢哌酮 /舒巴坦、阿米卡星、头孢吡肟的敏感性分别为 10 0 .0 0 %、76 .19%、6 1.90 %、5 2 .38%外 ,对其他抗菌药物包括 3代头孢菌素的敏感性均在 4 0 %以下 ,4 1株产 ESBL s酶的菌株 ,除对亚胺培南、头孢哌酮 /舒巴坦、哌拉西林 /他唑巴坦、头孢西丁、阿米卡星、氧氟沙星、氨苄西林 /舒巴坦的敏感性分别为 10 0 .0 0 %、97.5 6 %、75 .6 1%、6 0 .97%、5 6 .10 %、5 3.6 6 %、5 1.2 2 %外 ,其他的抗菌素的敏感性均在 4 0 .0 0 %以下。结论　产 Ampc酶及 ESBL s酶的细菌的耐药性不完全相同 ,菌株产酶类型不同需选用不同类型的抗菌药物。我们的研究结果还显示临床产 Ampc酶细菌与产 ESBL s酶细菌的分离率已达到相当高的?Objective To study resistant rates of strains continuously producing high AmpC β lactamase and/or spectrum β lactamas (ESBLs) to 18 antibiotics in Jinan area ,and to investigate the epidemic conditions of AmpC BLA and/or ESBLs producing strains Shandong provincial chest hospital.Methods A cefoxitin three dimensional test was used to detect strains which produced high AmpC, a disc diffusion screen test and a disc diffusion confirmatory test were used to detect ESBLs producing strains, and the bacterial susceptibility testing was tested by Lirby Bauer(K B) method as described in NCCLS.Results 21(15.11%) strains producing AmpC BLA were found using the cefoxitin three dimensional test, 41(29.50%) strains producing ESBLs were found using the disc diffusion confirmatory test. The susceptibility rate of the 21 strains producing AmpC BLA to imipenem, sulperazone, Amikacin, cefepime was 100.00%, 76.19%, 61.90%, 52.38% respectively, but The susceptibility rates to other antibiotics were all less than 40%. The susceptibility rates of the 41 strains producing ESBLs to imipenem, sulperazone, piperacillin+tazobactam, cefoxitin, Amilacin,Ofloxacin,Ampicillim+subactamwas100.00%,97.56%,75.61%,60.97%,56.10%, 53.66%, 51.22% respectively, but The susceptibility rates to other antibiotics were all less than 40% too.Conclusions The tolerance of strains producing AmpC BLA and/or ESBLs was not completely identical, therefore it should be very important for clinicians to select antibiotics correctly against infections according to the results of susceptibility tests. Our research showed the prevalence of strains producing AmpC BLA and/or ESBLs isolated from patients in hospitals was very high, so it was necessary for clinical laboratories to detect AmpC BLA and/or ESBLs and report in time.

关 键 词：克雷伯菌属 酶学 大肠杆菌 Β内酰胺酶类 代谢 微生物抗药性 

分 类 号：R378.996[医药卫生—病原生物学]