铜绿假单胞菌高活性β内酰胺酶检测及其耐药性分析  

Detection of highly active β-lactamases in Pseudomonas aeruginosa and its impact on antimicrobial susceptibility

作　　者：侯天文[1] 陈兴[1] 龙建国[1] 张健[1] 谢晓民[1] 李云婷[1] 

机构地区：[1]白求恩国际和平医院检验科,河北石家庄050082

出　　处：《中国抗感染化疗杂志》2004年第1期21-24,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的:研究临床分离铜绿假单胞菌(PA)持续高产AmpC酶和超广谱β内酰胺酶(ESBLs)的发生率及对耐药性的影响。方法:用改良三维试验法检验持续高产AmpC酶和ESBLs,用K—B法检测细菌耐药性。结果:我院2001年3月-2002年10月临床分离241株PA中,产生高活性β内酰胺酶共83株,检出率为34.4％,其中高产AmpC酶28株(11.6％),产ESBLs69株(28.6％),ESBLs与高产AmpC酶均阳性21株(8.7％),非AmpC酶、非ESBLs 7株(2.9％)。83株产酶PA主要分离自痰液(56株,67.5％)和烧伤创面分泌物(23株,27.7％)。易感人群以重症肺炎(34例,41.0%)、烧伤(23例,27.7 %)和肿瘤患者(10例,12.0%)为主。产酶株呈多重耐药性,对亚胺培南耐药率为10.8％,对受试的其他11种抗菌药物耐药率在49.4％～86.7％;除亚胺培南外,产酶株耐药率均明显高于非产酶株(X2≥16.1,P<0.005)。结论:我院PA临床株产ESBLs为主(约28.6％),其次是持续高产AmpC酶(约11.6％)。产酶株主要分离自重症肺炎、烧伤和肿瘤患者,其耐药率高,治疗用药应参考药敏试验结果。Objective: To investigate the prevalence of derepressed hyperproduction of AmpC β-lactamase and extended-spectrum β-lactamases (ESBLs) in Pseudomonas aeruginosa and its impact on antimicrobial susceptibility. Methods: A modified three-dimensional extract method was used to detect the phenotypes of P. aeruginosa strains harboring AmpC β-lactamase and /or ESBLs. Antimicrobial susceptibility was tested by Kirby-Bauer method. Results: Highly active β-lactamases were detected in 83 (34. 4%) of 241 P. aeruginosa strains isolated in our hospital from March 2001 to October 2002. Of the 83 isolates, 7 (2.9%) produced AmpC β-lactamase, 48(19.9%) produced ESBLs, 21 (8.7%) produced both, 7 (2.9%) produced non-AmpC non-ESBLs β-lactamases. The majority of highly active (3-lactamases producing strains were isolated from sputum (56 strains, 67. 5%) and wound exudates of burn patients (23 strains, 27. 7%). Most patients were ill with severe pneumonia (34 cases, 41. 0%) , burn infections (23 cases, 27. 7%) and malignant tumors (10 cases, 12. 0%). These 83 strains were multiple-drug resistant with resistance rate of 10. 8% to imipenem and 49. 4% - 86. 7% to the other 11 antimicrobials tested. The antimicrobial resistance rates were higher than those in β-lactamase negative strains except that to imipenem (X2≥16. 1, P< 0. 005). Conclusions: The most frequently detected β-lactamases in P. aeruginosa isolated from our hospital are ESBLs (28. 6%) , followed by derepressed hyperproducing AmpC β-lactamase (11.6%). β-lactamases producing strains are mainly i-solated from patients with severe pneumonia, burn infections, and maligant tumors. Antimicrobial agents should be chosen according to the results of antimicrobial susceptibility.

关 键 词：铜绿假单胞菌 持续高产AMPC酶 超广谱Β内酰胺酶 耐药性 

分 类 号：R446.5[医药卫生—诊断学]