崇明地区肠杆菌科细菌超广谱β-内酰胺酶的检测及耐药性研究

Detection and study of drug resistance of Extended Spectrum Beta-Lactamases in Enterobacteriaceae in Chongming area

目的了解本地区病人肠杆菌科细菌超广谱β-内酰胺酶（ESBLs）的产生情况，分析其耐药性，以指导临床合理用药。方法采用纸片扩散法，对肠杆菌科细菌进行β-内酰胺酶检测，并对产β-内酰胺酶菌和非产β-内酰胺酶菌进行药物敏感试验。结果374株肠杆菌科细菌中检出128株产生β-内酰胺酶，总阳性率为34．2％（128／374），其中肺炎克雷伯菌56株，阳性率为30．4％（56／184），大肠埃希菌61株，阳性率为37．7％（61／162），其它肠杆菌科细菌11株，阳性率为39.3％（11／28）。产β-内酰胺酶菌对17种常用抗生素耐药率明显高于非产β-内酰胺酶菌株，产β-内酰胺酶菌对三代头孢类、青霉素类、氨曲南及喹诺酮类等抗菌素耐药率均较高，碳青酶烯类的耐药率最低。结论产β-内酰胺酶菌在本地区已广泛存在，成为主要的耐药菌株，临床及时了解β-内酰胺酶菌株的耐药特点和变化趋势，有助千抗菌药物的合坪斌柽。

Objective To investigate the productive rates of ESBLs （extended spectrum beta-Lactamases） in Enterobacteriaceae, analyze the drug resistance of these strains in our area, and guide the rational use of antibiotics. Methods ESBLs-production was detected in Enterobacteriaceae, and the drug resistance were detected by disk diffusion test. Results 128 strains of ESBLs-producing were isolated from 374 strains of Enterobacteriaceae, the positive isolation rate was 34.2%. Fifty-six strains were Klebsiella pneumoniae （30.4%）, 61 strains were Escherichia coli （37.7%）, 11 strains were other Enterobacteriaceae （39.3%）. The ESBLs-producing strains had higher resistant rate to 17 kinds of usual agents than the non-ESBLs. The ESBLs-producing strains had higher resistance rate to the 1st, 2nd and 3rd generation of cephalosporins, penicillins, sulfanilamides and quinolones. The carbapenems showed the highest activities. Conclusions The ESBLs bacteria exist in our area at a high level and also is the main drug-resistant strains. It is important for clinicians to understand the resistance characteristics and the change of ESBLs-producing, and it is helpful to select antibiotics reasonably.