产超广谱β-内酰胺酶大肠埃希菌耐药谱的连续监测

Continuous Monitoring of Drug Resistance Spectrum of Escherichia coli Producing Extended-spetrum β-Lactamases

目的了解产超广谱β-内酰胺酶大肠埃希菌耐药谱的变化,为临床经验用药提供依据。方法采用法国Bio-Merieux公司的VITEK-60全自动细菌鉴定仪鉴定细菌,K-B单片琼脂扩散法做药敏试验,WHONET5.0分析软件对产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的药敏试验进行统计。结果检出912株大肠埃希菌,其中产ESBLs 386株,占42.3%;体外试验显示亚胺培南、美罗培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁、头孢他啶对产ESBLs大肠埃希菌有较高的抗菌活性;产ESBLs大肠埃希菌的耐药率均明显高于非产ESBLs菌。结论我院大肠埃希菌产ESBLs株主要是头孢菌素型(CTX-M型),ESBLs尚未有效控制,仍然处于较高水平;3年间产ESBLs大肠埃希菌耐药谱变化不大,亚胺培南、美罗培南对产ESBLs株未发现耐药,阿米卡星及哌拉西林/他唑巴坦具有良好的治疗效果。

OBJECTIVE To understand the changes in drug resistance spectrum of Escherichia coli producing extended-spectrum β-lactamases（ESBLs） and to guide the reasonable use of antibiotics. METHODS The bacteria were identified by the automatic analytical apparatus VITEK-60 made by Bio-Merieux Corporation in France. The drug susceptibility was tested with the Kirby-Bauer （K-B） method and the data were analyzed by the software of WHONET5.0. RESULTS Among 912 strains of identified E. coli,42.3% of them（386 strains） produced ESBLs. Tests in vitro showed that imipenem, meropenem, amikacin, piperacillin/tazobactam, cefoperazone/sulbactam, cefoxitin, and ceftazidime were effective to E. coli producing ESBLs. The drug resistance rate in E. coli producing ESBLs was higher than that in E. coli non-producing ESBLs. CONCLUSIONS The E. coli producing ESBLs isolated in our hospital is mainly type of cephalosporin（type of CTX-M）, ESBLs haven＇t been controlled and are still in high level. The drug resistance spectrum of E. coli producing ESBLs has changed few in 3 years. Strains resisting to imipenem and meropenem haven＇t been found, and amikacin and piperacillin/tazobactam have good effect in clinical use.