2008-2012年大肠埃希菌临床分布及耐药趋势分析

Analysis of clinical distribution and drug-resistant trend of Escherichia coli from 2008 to 2012

目的 研究长治市第二人医院2008年至2012年大肠埃希菌的临床分布特点及对常用抗菌药物的耐药趋势变化,为临床预防和控制大肠埃希菌感染提供依据.方法 对5年间从临床各种标本中分离的大肠埃希菌进行回顾性分析,菌株鉴定采用API及ATB鉴定仪,采用CLSI推荐的K-B法进行药敏试验和折点判读.ESBLs确证试验采用双纸片法.结果 共分离大肠埃希菌804株,其中产ESBLs 344株,占42.79％.804株大肠埃希菌中来自尿液标本426株,占52.99％;疫标本135株,占16.79％;脓和分泌物132株,占16.42％;血液标本39株,占4.85％.大肠埃希菌对左氧氟沙星、头孢唑啉、头孢呋辛、庆大霉素、妥布霉素的耐药率较高（＞50％）,且对左氧氟沙星的耐药率呈逐年上升趋势;对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星、呋喃妥因的耐药率较低（＜10％）;对亚胺培南的耐药率为0.结论 大肠埃希菌的检出率及其对多种抗生素的耐药率维持在较高水平,应根据药敏结果,合理应用抗菌药物,预防耐药菌的产生.

Objective To study E.coli clinical distribution characteristics and drug resistance to commonly used antimicrobial agents trend change in the second people＇ s hospital of Changzhi from 2008 to 2012,in order to provide the basis for clinical prevention and control of E.coli infection.Methods All kinds of E.coli isolated from clinical specimens in five years were retrospectively analyzed.API and ATB bacteria identification instrument were used for bacterial strains identification.K-B method recommended by CLSI was used for drug sensitive test and fold point interpretation.ESBLs was confirmed with double slip of paper method.Results A total of 804 strains of E.coli had been separated.There were 344 ESBLs-producing strains,accounting for 42.79％.Among the 804 strains of E.coli,426 strains were isolated from urine,accounting for 52.99％ ; 135 strains from sputum,accounting for 16.79％ ; 132 strains from pus or secretion,accounting for 16.42％ ; and 39 strains from blood,accounting for 4.85％.E.coli demonstrated much higher resistant rate to levofloxacin,cefazolin,cefuroxime,gentamicin,tobramycin（＞ 50％）,the resistant rate to levofloxacin had rising trend year by year,and E.coli had much lower resistant rate to cefoperazone/sulbactam,piperacillin/tazobactam,amikacin,nitrofurantoin.No strains were found to be resistant to imipenem.Conclusions Escherichia coli detection rate and the multiple antibiotic resistant rate of E.coli is maintained at a high level,it should be based on susceptibility results,rational use of antimicrobial drugs to prevent the generation of resistant bacteria.