产生ESBLs和AmpC酶的肠杆菌科细菌检测及耐药性分析

Detection and drug-resistant analysis of Enterobacteriaceae producing ESBLs and AmpC β-lactamase

目的了解我院产ESBLs和AmpC酶细菌的耐药性。方法对产ESBLs菌和产生AmpC酶菌进行表型的筛选和确证,测定21种药物的耐药性。结果 268株菌中检出ESBLs菌136株,检出率50.75%,AmpC酶菌116株,检出率43.28%。单产AmpC酶菌,单产ESBLs菌及产AmpC和ESBLs的菌对青霉素、第二、三代头孢菌素类药物的耐药率明显高于非产酶菌的耐药率,两者相比有显著性差异(P<0.05),多重耐药及泛耐药常见。结论 ESBLs与Amp酶已成为我院肠杆菌科细菌耐药的主要原因。碳青霉烯类、第四代头孢菌素、哌拉西林/三唑巴坦成为我院治疗院内感染的首选药。

Objective To acquare the drug resistance of ESBLs and AmpC β-lactamase in Enterobacteriaceae in our hospital. Methods To determine and sort out the phenotype of the Enterobacteriaceae that produced ESBLs and AmpC β-1actamase and detect the drug susceptibility of 21 antibiotics. Results Among 268 isolated strains, 136（50.75%） of them were detected to produce ESBLs, 116（43.28%） cases were detected to produce AmpC β- lactamase. Drug susceptibility test results show that the resistant rates of single-AmpC-positive strains, single - ESBLs -positive strains, AmpC-positive and ESBLs-positive strains to penicillin, the second and third generations of cephalosporin drugs were much higher than that of enzyme-negative strains. There was significant difference between two groups（P〈0.05）.Multiple resistance and generic drug resistance are common. Conclusion AmpC β-1actamase and ESBLs have been a critical cause of the drug-resistance in Enterobacteriaceae. Carbapenems, the fourth generation cephalosporin, piperacillin sodium and tazobactam sodium can be the first choice to treat nosocomial infections.