烧伤创面肠杆菌属细菌感染的耐药性调查

Antibiotics resistance of Enterobacterisolated from burn wounds

目的了解烧伤创面肠杆菌属细菌感染株的耐药性,为烧伤创面抗感染治疗时抗菌药物的选用提供科学依据。方法药敏试验采用K-B法,ESBLs和AmpC酶检测采用三维试验。结果 2010年1月-2011年12月从住院的烧伤患者创面标本中共分离获得72株肠杆菌属细菌,主要菌种是阴沟肠杆菌(ECL)54株,占75.00%,产气肠杆菌(EAE)12株,占16.67%;ECL和EAE对阿莫西林/克拉维酸和氨苄西林的耐药率均≥98.15%;第三代头孢耐药率为35.20%～66.67%,头孢吡肟为7.41%和33.33%,1株ECL对亚胺培南耐药;对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、喹诺酮类和氨基糖苷类的耐药率较低;三维试验证明ECL和EAE的产ESBLs检出率分别为25.93%和41.67%,AmpC酶阳性率为31.48%和33.33%,10株同时产ESBLs和AmpC酶。结论烧伤创面感染的肠杆菌属细菌主要是ECL和EAE,感染菌耐药率严重,产酶率较高,临床应加强医院感染的预防措施,重视细菌培养和药敏试验结果,实验室应及时向临床提供细菌产酶的信息,指导临床合理选择治疗用药。

OBJECTIVE To investigate the drug resistance of Enterobacter spp isolated from burn wound so to provide the scientific evidence for clinical anti-infection therapy.METHODS The drug susceptibility testing was performed by K-B method,and the ESBLs and AmpC β-lactamase were detected through the 3-D test.RESULTS From Jan 2010 to Dec 2011,a total of 72 strains of Enterobacter spp were collected from the burn wounds of the hospitalized patients,including 54（75.00%） strains of E.cloacae and 12（16.67%） E.aerogenes.The drug susceptibility testing result showed that the drug resistance rates of both E.cloacae and E.aerogenes to amoxicillin/clavulanic acid and ampicillin were higher than 98.15%,the resistance rates to third-generation cephalosporin varied between 35.20% and 66.67%,the resistance rates to cefepime were 7.41% and 33.33%,respectively.There was one strain of E.cloacae resistant to imipenem.The drug resistance rates to such antibiotics as cefoperazone/sulbactam,piperacillin/tazobactam,quinolones and aminoglycoside were relatively low.The 3-D test indicated that the detection rates of ESBLs-producing E.cloacae and E.aerogenes were 25.93% and 41.67%,respectively,the positive rates of AmpC β-lactamase were 31.48% and 33.33%,respectively,and there were 10 strains with both ESBLs and AmpC β-lactamase tested positive.CONCLUSION It is concluded that E.cloacae and E.aerogenes are the most common species of Enterobacter spp causing burn wound infections and are highly drug resistant,with high positive rate of enzyme producing.It is necessary for the hospital to strengthen the prevention of nosocomial infections and to focus on the bacterial culture and the drug susceptibility testing.The information of the enzyme-producing bacteria should be acquire through the laboratory test so as to guide the reasonable use of antibiotics.