临床产ESBLs大肠埃希氏菌的检测及耐药性研究

Study of the detection and drug resistance of the clinical producing ESBLs E.coli

目的了解产ESBLs大肠埃希氏菌(E.coli)感染及耐药状况,指导临床合理使用抗生素,控制院内感染.方法由VITEK32细菌鉴定仪分析得出,部分采用双纸片协同试验(DDST),必要时按NCCLS推荐的初筛试验、确证试验加以证实.结果产ESBLs E.coli主要来源于尿液、痰液和脓性分泌物,ESBLs阳性率为27.1%(88/325);IMP、AMC、SAM、SCF、TZP、TIM、FOT、CT、NIT、FEP耐药性较低,在0%～16.9%之间,青霉素类、1～3代头抱菌素类及单酰胺类如ATM耐药性高,在94.3%以上;氨基糖甙类、氟喹诺酮类抗生素耐药性低,在18.8%～52.3%之间.结论产ESBLs E.coli发生率和耐药性日趋严重;治疗时应避免使用青霉素类、1～3代头抱菌素类及单酰胺类如ATM抗生素,建议首选IMP、AMC、SAM、SAF、TCF、TZM、FIM、CT、NIT或头霉素类与氨基糖甙类或含酶抑制剂类复合氨基糖甙类抗生素联合用药;开展产ESBLs E.coli检测及耐药性研究对指导临床合理使用抗生素、了解其流行趋势和防止院内感染意义重大.

Objective To study the condition of infection and drug resistance ofthe E.coli,which produce ESBLs,and to direct the clinic to use antibiotic correctly and decrease nosocomial infections.Methods the VITEK 32 analyser can get it,partly should combine with DDST,and as NCCLS'recommendation use primary test and confirmed test to prove if necessary.Results TheE.coli,which produce ESBLs mainly from urine,spululm and puriform secretion;the ESBLs'positive rate Was 27.1%(88/325),the resistant rate of IMP,AMC,SAM,SCF,TZP,TIM,FOT,CT,NIT,FEP was lower,the E.coli's was 0%～16.9%,While penicillins and the 1～3'rd generation cepha losporins and monobactam(ATM)'s Washigher,mored than 94.3%;aminoglycosides and quinolones'resistant rate was low, between 18.8%～52.3%.Conclusion The occurance rate and drug resistance of The E.coli with production of ESBLs becoming more serious;the therapy should avoid to select PENS and 1～3rd generation cephalosporins and monobactam(ATM),and suggest selecting IMP,AMC,ASM,SCF,TZP,TIM,FOT,CT,NIT first,or combining with ceomycins and aminoglycosides,or β-lactams enzyme antagonist compound and aminoglycosides;There was great role to investigate the E.coliwith production of ESBLs infecton and drug resistance and use antibiotic correctly and investigate of epidemicity and decrease nosocomial infection.