产ESBLs肠杆菌科细菌的检测及耐药性分析

STUDY OF ANTIBIOTIC RESISTANCE IN CLINICAL ISOLATES OF ENTEROBACTERIA PRODUCING EXTENDED-SPECTRUM BETALACTAMASES

目的 了解产超广谱 β 内酰胺酶 (ESBLs)的肠杆菌科细菌的耐药性、耐药特点 ,指导临床用药。 方法 应用双纸片法检测 4 64株肠杆菌科细菌ESBLs,并用K B纸片扩散法测定其对 14种抗生素的耐药性。结果 阴沟肠杆菌、粘质沙雷菌、弗劳地枸橼酸杆菌、大肠埃希菌、肺炎克雷伯菌 5种肠杆菌产ESBLs的检出率分别为 4 0 .3 %、2 9.6%、2 8.6%、2 6.4 %、2 1.2 % ;5种产ESBLs的肠杆菌对氨苄西林、哌拉西林、头孢唑啉、头孢呋辛的耐药率为10 0 % ;对头孢三嗪、头孢噻肟、头孢哌酮、头孢他啶表现为敏感者占 7%～ 2 6% ;产ESBLs株与不产酶株对三代头孢的耐药率有显著差异 (P <0 .0 1) ;未见产酶株对泰能耐药。结论 检出ESBLs细菌可指导临床用药 ,对ESBLs细菌的治疗需要β 内酰胺类抗生素加酶抑制的复合制剂 。

Objictive To determine the prevalence of strains producing ESBLs among Enterobacteriaceae,and investigate the antibiotic resistance of these strains.Methods 125 strains of ESBLs producing Enterobacteriaceae were determined by a double disk synergy test and antibiotic susceptibility test by Kirby Bauer test.Results The detection rate of ESBLs producing E·cloacae,S·marcescence,C·freundii,E·coli and K·pneumoniae was 40.3%,29.6%,28.6%,26.4%,21.2%,respectively.The resistance rate of ESBLs producing strains to ampicillin,piperacillin,cefazolin,cefu roxime was 100%,the susceptibility rate to ceftriaxone,cefotaxime,cefoperazone,ceftazidime was 7～26%,lower than that of non ESBLs producing strains,showing significent difference (P<0.01).Conclusion To deal with the ESBLs producing strains,β lactama/β lactamase inhibitor combinations can be used,imipenem may be the first choice.