产超广谱β-内酰胺酶大肠埃希菌的临床分布及耐药性分析

Distribution and drug resistance of Escherichia coli producing extended-spectrum β lactamases in a hospital

目的探讨医院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌感染临床分布情况及其耐药情况,为临床合理用药提供依据。方法收集2010～2011年院住院并发大肠埃希菌感染患者,分离大肠埃希菌,采用双纸片协同试验(表型确证试验)检测ESBLs,药敏纸片法进行药敏试验。结果 297株大肠埃希菌,2010年135株,2011年162株;常见部位主要为呼吸道和泌尿道,分别为118和64株,分别占39.73%和21.55%;手术伤口及其他伤口、引流液、血液及其他标本分别占13.80%、9.09%、6.40%和9.43%。大肠埃希菌对阿莫西林、氨苄西林耐药率较高,均>70%,对亚胺培南、哌拉西林/他唑巴坦、阿米卡星耐药率较低,分别为0、7.41%和15.49%。2011年大肠埃希菌对阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、阿米卡星、环丙沙星、氨曲南和复方新诺明的耐药率高于2010年,大肠埃希菌耐药率逐年升高。297株大肠埃希菌共检出产ESBLs菌株71例,检出率为23.91%,产ESBLs菌株耐药性显著高于不产ESBLs菌株。结论大肠埃希菌及产ESBLs大肠埃希菌耐药严重,临床应根据药敏结果合理应用抗菌药物。

Objectives To study the distribution and characteristics of antibiotic resistance of Escherichia coli producing extended-spectrum β-lactamases （ESBLs） in a hospital and to guide clinical drug use. Methods The antibiotic resistance of E. coli to antibiotics was detected using the K-B disc diffusion method. ESBL-producing strains were detected, and susceptibility to all antibiotics were determined in accordance with criteria of the CLSI. Results A total of 297 strains of E. coli were isolated, with 135 strains isolated in 2010 and 162 strains isolated in 2011. Of the total strains, 118 were i solated from respiratory tract specimens and 64 were isolated from urinary tract specimens. E. coli and ESBL-producing strains of E. coli had severe multidrug resistance. E. coli had resistance to amoxicillin and ampicillin of more than 70%, resistance to imipenem of 0 %, resistance to piperacillin and tazohactam of 7.41%, and resistance to amikacin of 15.49 %. E. coli was more resistant in 2011 than in 2010. A total of 71 strains of ESBL-producing bacteria were detected at a rate of 23.91β. ESBL producing bacteria had greater resistance than non-ESBL producing bacteria. Conclusion ESBl.-pro ducing strains of E. coli have severe muhidrug resistance. Antibiotics should be chosen and used rationally in accordance with results of drug susceptibility testing.