常见肠杆菌科细菌ESBLS检测及耐药性分析  

DETECTION OF EXTENDED-SPECTRUM β-IACTAMASE AND ANALYSIS OF ANTIBIOTIC RESISTANCE IN THE USUAL STRAINS OF ENTEROBACTERIACEAE

作　　者：李宪[1] 杜鹏超[2] 唐银[1] 刘文恩[1] 郭思建[1] 张晋湘[1] 

机构地区：[1]中南大学湘雅医院检验科,长沙410008 [2]湘雅医学院医学检验系

出　　处：《中国现代医学杂志》2003年第9期61-64,共4页China Journal of Modern Medicine

摘　　要：目的 :分析产ESBLs(超广谱 β内酰胺酶 )的常见肠杆菌科细菌的耐药性及耐药特点以及病人感染产ES BLs菌的危险因素 ,以指导临床用药。方法 :用K -B法作药敏试验 ,并按NCCLS规定的表型确认实验检测14 0株肠杆菌科细菌是否产ESBLs。结果 :在检测的 14 0株肠杆菌科细菌中 ,ESBLs总阳性率为 36 .4 % ,大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌的产酶率分别为 33.3%、35 .0 %、4 2 .5 %。产ESBLs菌对 11种抗生素 (妥布霉素、庆大霉素、阿米卡星、诺氟沙星、氧氟沙星、环丙沙星、头孢他啶、头孢噻肟、头孢曲松、哌拉西林、复方新诺明 )的耐药率与不产ESBLs菌相比有显著差异 (χ2 检验 ,P <0 .0 5 )。对四种抗生素 (泰能、哌拉西林 /他唑巴坦、阿莫西林 /舒巴坦、舒普松 )的耐药率与不产ESBLs菌相比较无显著差异 (χ2 检验 ,P >0 .0 5 )。产ES BLs菌与不产ESBLs菌对泰能的耐药率分别为 1.9%和 0。各病区产ESBLs菌的分离率以重症监护病房ICU最高 (5 5 .1% ) ,其次是呼吸科病房 (4 2 .0 % )、神经内科病房 (39.1% )、其他病房 (15 .4 % )、干部病房 (12 .5 % )、门诊部 (7.2 0 /5 )。结论 :治疗产ESBLs菌引起的感染应选用泰能、头霉素类以及含 β -内酰胺酶抑制剂的复合物。ICU病房是产ESBLs的高发区 ,呼吸科病房和?Objective:To determine the productive rates of ESBLs(Extended Specturm β-Lactam-ase) in the clinical isolates of Enterobacteriaceae and investigate the antibiotic resistance of these strains,and investigate the risk factors for infection with ESBLs -producing Enterobaceriaceae.Methods:140 strains of Enterobacteriaceae were determined by a disk diffusion confirmatory test of NCCLS.Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion method. Results:In this sample,the productive rate was 36.4%. the productive rate of E.coli, E.cloacae and K.pneumoniae were respectively 33.3%, 35.0%, 42.5%. The resistance rate of ESBLs-producing strains to eleven kinds of antibiotics (Tobyamycin,Gentamycin, Amikacin, Norfloxacin, Oflxacin, Ciprofloxacin, Ceftazidime, Cefotaxime, Ceftriaxone, Piperacillin, SMZ/TMP(Suifamethoxazole/Trimethoprin) was higher than that of non-ESBLs-producmg strains, There were significant differences between them (χ 2 test, P <0.05).there were not significant differences between the resistance rate of ESBLs-producing stratus to four kinds of antibiotics (Imipenum, Piperacillin/Tazobactam, Amoxicillin/Clavulanic acid, Cefoperazone/sulbactam) and that of non-ESBLs-producing strains (χ 2 test, P >0.05).The resistance rate of ESBLs-producmg strains and non-ESBLs-producing strains to Imipenum were respectively 1.9% and 0 The wards isolated rate of ESBLs-producing strains, in the following order .55.1% in ICU (intense care unit) wards, 42.0% in respiratory system wards, 39.1% in neurologywards, 15.4% in other wards, 12.5% in geriatric wards, 7.2% in outpatient department. Conclusions: To deal with ESBLs-producing Enterobacteroaceae infection, Imipenum, Cephomycm and β-Lactamase inhibitor combinations can be used. ICU had the highest isolated rate of ESBBLs, respiratory system wards and neurology wards had the higher isolated rate of ESBLs, ESBLs-producing enterobacteriaceae was easy to infect in such patients: the long-period use of the third-gen

关 键 词：超广谱Β-内酰胺酶 抗生素耐药 危险因素 

分 类 号：R378.2[医药卫生—病原生物学]