210株肠杆菌科细菌产ESBLs检测及耐药性调查

Detection of ESBLs in 210 isolates of Enterobacteriaceae

目的调查分析三种肠杆菌科细菌产ESBLs情况及其对11种抗生素的耐药性与耐药特点.方法对四川大学华西医院2003年7月～2004年1月从临床分离的210株对第三代头孢菌素(头孢他啶、头孢噻肟、头孢曲松)任一种MIC值≥2μg/ml的肠杆菌科细菌(主要为大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌)采用琼脂二倍稀释法测定11种抗菌药物的最低抑菌浓度(MIC).结果三种肠杆菌科细菌对环丙沙星的耐药率(以中敏和耐药合并计算)均超过50%;有90%的分离株对亚胺培南敏感.在氨基糖苷类抗生素中,以阿米卡星和依替米星的抗菌活性最强,阴沟肠杆菌对阿米卡星和依替米星耐药率较高,分别为56.77%和65.38%.结论肠杆菌科细菌对临床常用抗菌药物的耐药率均较高,多重耐药现象普遍,仅亚胺培南对其抗菌活性最强.

Objective To study the resistance of extended spectrum βlactamase producing clinical (isolates) in Enterobacteriaceae to 11 antimicrobial agents. Methods A total of 210 strains of Enterobacteriaceae including Escherichia coli, Klebsiella pneumonia and Enterobacter cloacae, were collected from West China Hospital of Sichuan University from July 2003 to January 2004. The MICs of 11 antibacterial agents against the clinical isolates were detected by double agar dilution method. Results The resistant rate of E.coli, (K.pneumonia) and E.cloacae in Enterobacteriaceae to ciprofloxacin was above 50%. Imipenem was the most (active) agent against 90% of the isolates, and the aminoglycosides, amikacin and etimicin were active against the clinical isolates. Conclusions The situations of multidrug resistance of ESBLs-producing strains in (Enterobacteriaceae) was severe and prevalent. Imipenem is still the most active antibiotic for treatment of the (infections) caused by these resistant strains. The aminoglycosides should be prudently used when combined with other antibiotics in empirical treatment or evidence-based prescribed according to the results of in vitro combination susceptibility test.