某市8年间大肠埃希氏菌耐药性变迁及产超广谱β-内酰胺酶检测

STUDY OF THE ANTIBIOTIC RESISTANCE TREND AND DETECTION OF PRODUCING EXTEND-SPECTRUM BETA-LACTAMASES OF CLINICAL ISOLATED ESCHERICHIA COLI FROM 1997 TO 2004 IN QINGYUAN DISTRICT

目的：分析清远地区1997年7月至2004年12月间门诊住院病人各种标本中大肠埃希菌的耐药性及其产超广谱β-内酰胺酶（ESBLs）情况，以便更好地指导临床用药。方法：应用微生物分析系统MicroScan AutoScan-4进行鉴定，并用仪器专家系统判断可疑ESBLs菌株，用纸片扩散法表型确证试验检测ESBLs。结果：（1）分离革兰阴性杆菌中检出大肠埃希菌749株，占22．3％；2000年及2004年大肠埃希菌检出率明显增高（P〈0．05）；（2）头孢西丁、头孢他啶、头孢呋肟、头孢噻吩等抗生素的耐药性，不同时期差异有统计学意义（P〈0．01）；8年来哌拉西林／f也唑巴坦。对大肠埃希菌耐药性稳定在10％以下，亚胺培南、阿米卡星的耐药性则稳定在20％以下；氨苄西林、哌拉西林、头孢噻吩等抗生素的耐药率均在70％以上；（3）本组产ESBLs大肠埃希菌阳性率44．1％（171／388），对头孢菌素类、氨苄西林、哌拉西林、环丙沙星、妥布霉素、复方新诺明呈多重耐药，耐药率42．6％～95．6％，显著高于非产ESBLs大肠埃希菌（P〈0．01）；对亚胺培南、哌拉西林／他唑巴坦具有较低耐药性。结论：本地区医院内大肠埃希菌感染较严重，对多种抗生素耐药。在临床治疗中应严格掌握抗生素应用指征，应根据抗生素敏感试验选择敏感药物进行合理用药并检测相应的产ESBLs情况。

Objective： To analyse the antibiotic resistance and producing extend - spectrum beta- lactamases of Escherichia coli from urine in QingYuan district from July, 1997 to December, 2004, To provide the reference for the clinical practice. Methods： The sensitivity of Escherichia coli to 20 antibiotics were tested by the Microscan AutoScan - 4 and the extend spectrum β - lactamase （ESBLs） were identified by discagar diffusion method. Results： （1） 749 Escherichia coil were tested from isolated 3 663 gram negative bacillus from July, 1997 to December, 2004. The positive rate was 22.3%. The positive rate in 2000 and 2004 was significant higher than the overall （P 〈 0.05） （2） There were significant differences in the resistances of cefoxitin, ceftazidime, cefuroxime, in different periods （P〈0.01）. For eight years the drug resistance of piperacillin/Tazobactam firmly keep on below 10%, and that of imipenem and Amikacin are bdow 20%. The resistances of ampicillin, piperacillin, eefalotin were all above 70%. （3） The positive rate of Escherichia coil producing ESBLs was 44.1% （171/388） in this study. And the bacteria expressed Multi - Drug resistance to phalosporins, ampicillin, piperacillin, ciprofloyamin, tobiamycin, and trimeth oprim/sultamethoxazole. The resistance rate ranged 42.6 % - 95.6 % was significantly higher than that of Escherichia coil not producing ESBIs （P 〈 0.01）. The bacteria was highly sensitive to Imipenem ,and piperacillin/Tazobactam. Conclusion： There was a ascend trend of Escherichia coil hospital infection in this district. The positive rate of Escherichia coil producing ESBLs was high which had multi - drug resistance. The susceptible antibiotics sbould be ehoosen reasonably based on the susceptible experiment of antibiotic and the ESBLs should be invested in the infection of Escherichia coil.