儿童泌尿系感染产ESBLs大肠埃希菌的检测及耐药性分析

Extended-spectrum -lactamases and the antibiotic resistance in uropathogeni escherichia coli in children

目的了解儿童泌尿系感染分离大肠埃希茵中产ESBLs菌株的发生率和产ESBLs菌株和非产Es—BLs的耐药性。方法儿童泌尿系感染分离的产ESBLs大肠埃希菌48株，通过cIJSI表型确证试验（纸片增强法）检测产ESBLs菌株，琼脂稀释法进行药敏试验。结果48株儿童泌尿系感染分离的大肠埃希菌中，产ESBLs菌株的发生率为45．8％（22／48），其中复杂性尿路感染产ESBLs菌株高达66．7％（12／18）。产ESBLs茵株对氨苄西林，第一、二代头孢菌素，头孢噻肟耐药显著；对头孢他啶、头孢吡肟和阿莫西林／克拉维酸耐药率超过30％；对头孢哌酮／舒巴坦、头孢美唑、阿米卡星耐药率在30％以下；对美罗培南耐药率为0。非产ESBLs菌株对氨苄西林，第一、二代头孢菌素类耐药率较高，对其他抗茵药物均较为敏感。产ESBLs菌株对第一、二代头孢菌素，头孢噻肟，头孢他啶，头孢吡肟耐药率显著高于非产ESBLs菌株（P〈0．05）。结论儿童泌尿系感染分离大肠埃希菌中产ESBLs茵株的发生率较高，产ESBLs菌株多重耐药显著，临床应加强检测和监测。

Objective To investigate the prevalence of extended-spectrum -lactamases（ESBLs） and the antibiotic resistance in uropathogeni escherichia coli in children. Methods A total of 48 uropathogenic escherichia eoli strains isola- ted, ESBLs-producers were detected by CLSI phenotypic confirmatory test and susceptibilities were tested by agar dilution method. Results 45.8% of isolates were ESBLs producers in those isolates, and ESBLs-producers account for 66.7% strains in the complicated urinary tract infection. ESBLs producers were highly resistant to ampicillin, cefazolin, cefuroxime and cefotaxime. The resistant rate of ceflazidime, cefepime, amoxicillin-clavulanic acid was more than 30%, cefoperazone- sulbactam, cefmetazole and aimikacin was less than 30% , none was resistant to meropenem in ESBLs producers. The re- sistant rate of ampicillin, cefazolin, cefuroxime was more than 40% and most were susceptible to other antimicrobial agents in non ESBLs producers. The resistant rate of cefazolin, cefuroxime, cefotaxime, ceftazidime and cefepime was significantly higher in ESBLs producers than that in non ESBLs producers. Conclusions With resistance to most of antimicrobial a- gents, ESBLs-producers are highly prevalent in uropathogeni escherichia coli isolates in children, so more attention should be paid to survey and detect those strains.