94株产气肠杆菌的临床分布与耐药性分析

Clinical distribution and drug resistance of 94 strains of Enterobacter aerogenes

目的了解产气肠杆菌的临床分布及耐药性。方法用常规方法检出可疑菌落,用法国生物梅里埃公司ID 32E条和ATB G-5条做菌种鉴定与药敏试验;分别用复合纸片表型确认试验和FOX琼脂平板试验检测ESBLs和AmpC酶。结果临床标本主要来自痰液,占52.1%,其次为中段尿,占16.0%;临床科室中呼吸内科和肝胆外科检出最多,分别占43.6%和17.0%;亚胺培南、美罗培南对所有菌株均敏感;头孢吡肟和哌拉西林/他唑巴坦的耐药率<16.0%;产气肠杆菌对阿莫西林、头孢噻吩、头孢西丁的耐药率均>95.0%,对其余β-内酰胺类抗菌药物均有一定程度的耐药,对氨基糖苷类、喹诺酮类、磺胺甲噁唑/甲氧苄啶耐药率较低;ESBLs和AmpC酶的检出率分别为16.0%和11.7%。结论产气肠杆菌临床主要来自痰液标本及呼吸内科;所有菌株均对亚胺培南、美罗培南敏感,对阿莫西林、头孢噻吩、头孢西丁的耐药率最高;产ESBLs和AmpC酶菌株已占一定比例。

OBJECTIVE To investigate the clinical distribution and antibiotic resistance of Enterobacter aerogens. METHODS Suspicious colonies were detected by conventional method, Meria ID 32E and ATBG-5 were used for bacterial identification and the drug susceptibility testing; complex phenotypic confirmatory test paper and FOX agar plate assay were respectively adopted to detect ESBLs and AmpC enzymes. RESULTS Of the clinical specimens, the highest detection rate （52. 1 %）was sputum, followed by the midstream urine （16.0 %）; of the clinical departments, the detection rates of respiratory medicine and hepatobiliary surgery were 43. 6% and 17.0% ; imipenem and meropenem were susceptible to all the isolates% the drug resistance rates to cefepime and piperacillin/tazobactam were lower than 16.0%; the drug resistance rates to amoxicillin, cefalotin and cefoxitin were all higher than 95.0%, a certain degree of resistance to other β-1actam antibiotics; the resistance rates to aminoglycosides, fluoroquinolones, and sulfamethoxazole/trimethoprim were relatively low ; the detection rates of ESBLs and AmpC were respectively 16.0% and 11. 7%. CONCLUSION E. aerogens are mainly isolated from sputum specimens and department of respiratory medicine, all the isolates are susceptible to imipenem and meropenem, and the resistance rates to amoxicillin, cefalotin and cefoxitin are the highest; ESBLs and AmpC- producing strains have occupied certain proportion.