肝病患者医院感染大肠埃希菌产β-内酰胺酶的分类检测及耐药性分析

Antimicrobial Susceptibility and Distribution of β-Lactamases Producing Escherichia coli Isolated from Hepatopathy Patients

目的研究肝病患者医院感染大肠埃希菌(ECO)所产各种β-内酰胺酶(-βlase)分布情况及其耐药性,为临床合理用药提供依据。方法采用多底物纸片法(协同法、拮抗法)、超广谱β-内酰胺酶(ESBLs)确认试验、AmpC酶检测法检测38株肝病患者医院感染ECO所产各种-βlase,采用琼脂扩散法分析其耐药性。结果38株ECO总-βlase检出率为68.4%,其中产青霉素酶13株(34.2%),产广谱酶5株(13.2%),产ESBLs 8株(21.1%),未检出AmpC酶、复合产酶、碳青酶烯酶;非产酶ECO对5大类9种抗菌药物均敏感;26株产β-内酰胺酶ECO中,氨苄西林、头孢唑林、头孢噻肟、亚胺培南、庆大霉素、阿米卡星、环丙沙星、复方新诺明、四环素耐药率分别为100.0%、50.0%、30.8%、0、61.5%、15.4%、73.1%、61.5%、69.2%。结论医院感染ECO-βlase检出率高,以青霉素酶、ESBLs为主,产酶菌株对亚胺培南、阿米卡星敏感。

OBJECTIVE To study the antimicrobial susceptibility and distribution of the β-lactamases producing Escherichia coli from hepatopathy patients. METHODS Thirty-six β-lactamases producing E. coli strains from hepatopatby patients were detected with a multi-disk test Csynergy test, antagonized test for the inducible AmpC β-lactamases （IABLs）3, AmpC β-lactamases （ABLs）phenotype test and extended-spectrum β-lactamases（ESBLs） comfirmation test,and the susceptibility of antimicrobial agents with K-B test. RESULTS Twenty-six strains of 38 strains produced the β-lactamases （68. 4%）, 13 （34. 2%）strains produced penicillinases, 5 （13. 2%）strains produced broad-spectrum β-lactamases or penicillinases and 8 （21.1%）strains produced ESBLs alone. All were not detected out to produce ABLs and carbapenem-hydrolyzing β-lactamases（CHBLs） ; All nonnproducing β-lactamases strains were sensitive to 9 kinds of antimicrobial agents; but in the 26 strains producing β-lactamases, the resistant rate to AMP, KZ, FTX, IMP, AK, CN, CIP, SXT and TET were 100.0%, 50.0%, 30. 8%, 0, 61. 5%, 15.4%, 73.1%, 61.5%, and 69.2%, respectively. CONCLUSIONS The rate of β-lactamases producing E. coli from hepatopathy patients is high. The main types of β-lactamases are penicillinases and ESBLs. Most strains producing β-lactamases are susceptible to imipenem and amikacin.