临床分离大肠埃希菌的科室分布及耐药性变迁

Distribution and change of drug-resistance of isolated Escherichia coli in clinical specimens

目的：了解温岭地区大肠埃希菌的耐药变迁,为临床治疗提供参考,为控制院内感染提供科学依据。方法：收集2000-2007年临床分离的613株大肠埃希菌,采用ATB微生物鉴定仪进行细菌鉴定和药敏试验。结果：大肠埃希菌主要分布在儿科（23.3%）、大内科（17.0%）、ICU（8.0%）、泌尿外科（7.0%）和脑外科（5.9%）。613株大肠埃希菌对氨基糖苷类和喹诺酮类的耐药率出现先高后低现象,对哌拉西林达63.3%-90.7%、一代头孢菌素高达79.6%-88.5%、三代头孢呈逐年上升（6.7%-56.5%）,对β-内酰胺类抗菌药物与酶抑制合剂的耐药率较低,对亚胺培南耐药率〈1.0%。大肠埃希菌产ESBLS菌株在逐年增加（28.4%-77.1%）。结论：大肠埃希菌产ESBLS和耐药性仍呈增长趋势,临床上在治疗大肠埃希菌感染时,应根据药敏试验结果选择敏感的抗菌药物,以提高疗效,减少医院感染。

Objective：To investigate the drug resistance change of Escherichia coli in Wenling to offer suggestions for clinic and to provide scientific basis for controlling hospital onset of infection.Methods：A total of 613 strains of E.coli isolated from specimens of hospitalized patients from 2000 to 2007 were studied.Bacterial identification and antibiotic susceptibility test was performed with ATB Expression microbe identification system.Results：E.coli mainly distributed in departments of pediatrics（23.3%）,macro internal medicine（17.0%）,Intensive Care Unit（ICU）（8.0%）,urology（7.0%） and cerebral surgery（5.9%）.The resistance rates of E.coli to aminoglycosides and quinolones were first high later low.Rate to piperacillin waved from 63.3% to 90.7%.Rates to first generation cephalosporins were high,fluctuating from 79.6% to 88.5%.Rates to third generation cephalosporins increased year by year from 6.7% to 56.5%.But rates to β-lactam/β-lactamase inhibitor combinations were relatively low.Rate to imipenem was below 1%.The proportion of the extended spectrum beta-lactamases（ESBLs）-producing strains of E.coli increased year by year from 28.4% to 77.1%.Conclusion：Beta-lactamase production and bacterial resistance of E.coli is still on the rise.To ensure effective treatment and decrease the infection of E.coli in hospital,the antibiotics sensitive to E.coli should been used on the basis of antibiotic susceptibility test when the infection of E.coli was treated clinically.