术中胆道大肠埃希菌的检测及其耐药性分析

Monitoring and Antibiotic Resistance Analysis of Escherichia coli During Biliary Operation

目的了解胆道大肠埃希菌感染及其耐药情况。方法对2003-2005年住院并接受胆道手术的患者在术中取胆囊或胆管中胆汁进行细菌培养,采用K-B法测定14种常用抗菌药物的敏感性,同时用双纸片协同法和改良三维试验方法分别检测产超广谱β-内酰胺酶(ESBLs)和AmpC酶。结果135株大肠埃希菌共检出产ESBLs菌41株,检出率30.4%,产AmpC酶菌7株,检出率5.2%;药敏试验结果表明,美罗培南、亚胺培南、头孢哌酮/舒巴坦、环丙沙星、阿米卡星对大肠埃希菌仍有较好的抗菌效果。结论大肠埃希菌是胆道感染的主要病原菌,其中产ESBLs和(或)产AmpC酶的菌株对第三、四代头孢菌素治疗无效,术前过早、过多使用广谱抗菌药物是产酶菌株增多的主要原因。

OBJECTIVE To investigate the infection and drug-resistance of Escherichia coli. METHODS Double disk diffusion test and improved three-dimensional test were adopted to test ESBLs and AmpC of 135 E. coli strains obtained from bile cultivation from operations of biliary inpatients in our hospital from 2003 to 2005, and KingBauer＇s was used to test the sensitivity of 14 kinds of common antibiotics. RESULTS The detection rate of ESBLs producing bacteria was 30. 4% （41 strains）, and that of AmpC producing bacteria was 5.2% （7 strains） ; drugsensitivity test indicated, that E. coli was sensitive to meropenem, imipenem, eefoperazone / subaetam, eiprofloxaein and amikaein. CONCLUSIONS E. coli is a main bacterium in biliary infection, and the strains producing ESBLs and/or AmpC; are resistant to the eephalosporins of third and fourth generatiom prematurely and excessively using broad-spectrum antibiotics before operation is the primary cause to increase in enzyme-producing strains.