革兰阴性杆菌超广谱β-内酰胺酶检测结果分析

Detection of extended-spectrumβ-lactamase-producing gram-negative bacilli causing infections

目的探讨革兰阴性杆菌超广谱β-内酰胺酶(ESBLs)检测结果,为其临床研究提供可参考依据。方法留取2009年1月-2012年12月感染患者痰液、尿液及切口渗液等标本进行培养,共检出1 440株革兰阴性杆菌,采用复合纸片法检测是否产ESBLs,并对其进行相应的药敏分析。结果 1 440株革兰阴性杆菌中产ESBLs菌720株,检出率为50.0%,其中大肠埃希菌检出率最高,为69.6%,其次为阴沟肠杆菌,检出率为57.9%,而奇异变形菌与嗜麦芽寡养单胞菌均为非产ESBLs;革兰阴性杆菌无论其是否产ESBLs对美罗培南、亚胺培南的耐药率均为0,其次为产ESBLs菌对阿米卡星耐药率为16.7%、非产ESBLs菌耐药率为5.6%;产ESBLs菌除美罗培南、亚胺培南及阿米卡星外,耐药率均>50.0%;对氨苄西林的耐药性最高,产ESBLs菌耐药率达100.0%,非产ESBLs菌耐药率为81.8%。结论产ESBLs的耐药菌有较强的耐药性,在临床工作中需要对其进行检测,及时了解患者的耐药性,以便更好的给予患者调整药物治疗。

OBJECTIVE To explore the extended-spectrumβ-lactamases（ESBLs）-producing gram-negative bacilli so as to provide reliable bases for clinical study.METHODS The sputum,urine,and incision exudates specimens were collected for bacterial culture feom Jan 2009to Del 2012,totally 1 440strains of gram-negative bacilli have been isolated,the complex pieces of paper test was conducted to determine whether the strains produced the ESBLs,and the drug susceptibility testing was performed.RESULTS Among the 1 440strains of gram-negative bacilli,there were 720（50.0%）ESBLs-producing strains,of which the isolation rate of Escherichia coli was the highest（69.6%）,followed by Enterobacter cloacae（57.9%）;Proteus mirabilis and Stenotrophomonas maltophilia did not produce the ESBLs.The drug resistance rates of the both the ESBLs-producing and the non-ESBLs-producing gram-negative bacilli to meropenem and imipenem were 0;the drug resistance rate of the ESBLs-producing strains to amikacin was 16.7%,the non-ESBLs-producing strains 5.6%;the drug resistance rates of the ESBLs-producing strains to all the antibiotics were more than 50.0%except for meropenem,imipenem,and amikacin;the drug resistance rate to ampicillin was the highest,the ESBLs-producing strains 100.0%,the non-ESBLs-producing strains 81.8%.CONCLUSIONThe ESBLs-producing strains are highly resistant;it is necessary for the clinician to conduct the detection and understand the drug resistance in a timely manner so as to adjust the drug therapy.