上海部分地区肠杆菌科细菌产超广谱β-内酰胺酶情况及药敏监测

Detection of extended-spectrum β-lactamases and drug sensitivity test in clinical isolates of the family Enterobacteriaceae in Shanghai

目的 了解上海地区肠杆菌科细菌产超广谱 β 内酰胺酶 (ESBLs)的情况 ;比较产ESBLs菌与非产ESBLs菌对 11种抗生素的耐药率。方法 收集 1999年 3月～ 1999年 10月上海地区 4家医院分离的肠杆菌科细菌 10 2 6株 ,用双纸片协同扩散法检测ESBLs ,用Kirby Bauer琼脂扩散法作药敏试验。结果 10 2 6株肠杆菌科细菌中 ,共检出产ESBLs菌 35 2株 ,检出率为 34 31% ,其中肺炎克雷伯菌为 37 40 % ,大肠埃希菌为 30 2 1% ,阴沟肠杆菌为 41 82 % ;除亚胺培南 西司他丁和头孢美唑外 ,产ESBLs菌对其它 9种抗生素的耐药率均显著高于非产ESBLs菌 (P <0 0 1) ;亚胺培南 西司他丁对产ESBLs菌的耐药率最低。结论 上海地区肠杆菌科细菌产ESBLs情况严重 ,临床实验室有必要常规检测肠杆菌科细菌是否产ESBLs;产ESBLs菌对抗生素耐药性比非产ESBLs菌严重 ,亚胺培南 西司他丁和头孢美唑是治疗由产ESBLs菌引起感染的有效抗生素。

Objective To investigate extended spectrum β lactamases (ESBLs) production in clinical isolates of the family Enterobacteriaceae in Shanghai, and compare the resistant rates of ESBLs producing strains and non ESBLs producing strains to 11 antibiotics. Methods Double disk synergy test was used to detect ESBLs in 1 026 strains of the family Enterobacteriaceae; Kirby bauer agar diffusion method was used to judge drug sensitivity. Results 34.31% of strains of the family Enterobacteriaceae were considered ESBLs producers by double disk synergy test. The prevalences of ESBLs in isolates of Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae were 37.40%, 30.21% and 41.82% respectively. Except Imipinem and Cefmetazole, the resistant rates of ESBLs producing strains to other 9 antibiotics were much higher than that of non ESBLs producing strains( P <0.01). The resistant rates of Imipinem to ESBLs producing strains were the lowest. Conclusions The prevalence of ESBLs in clinical isolates of the family Enterobacteriaceae in Shanghai was high; it is necessary for clinical laboratory to detect ESBLs in clinical isolates of the family Enterobacteriaceae routinely. The resistant rates of ESBLs producing strains to most antibiotics were high. Imipinem and Cefmetazole were the effective antibiotics to infections caused by ESBLs producing strains.