清远市1997～2000年大肠埃希氏菌临床分离株的耐药性监测与分析

Analysis and detection of antibiotic resistance trend of clinical isolated Escherichia coil form 1997～2000 in Qingyuan district

目的 观察清远地区 1997年 7月至 2 0 0 0年 12月间大肠埃希氏菌临床分离株的耐药趋势及部分菌株产超广谱β-内酰胺酶 (ESBL s)的流行情况 ,指导临床用药。方法 应用 Micro Scan Auto Scan- 4专用NC鉴定板检测 36 1例大肠埃希氏菌对 16种抗生素的敏感程度 ,根据仪器专家系统筛选产 ESBL s的菌株。结果 (1) 1997年 7月至 2 0 0 0年 12月间所分离的 15 5 5株革兰氏阴性杆菌中检出大肠埃希氏菌 36 1株 ,占2 3.2 % ;2 0 0 0年大肠埃希氏菌检出率较 1999年明显增高 (P<0 .0 5～ 0 .0 0 5 ) ;(2 )阿米卡星、氨曲南、头孢西丁、头孢他啶、头孢呋辛、环内沙星、妥布霉素等抗生素的耐药性 ,不同时期存在非常显著性差异 (P<0 .0 0 5 ) ;氨曲南、头孢西丁、头孢他啶的耐药性以 2 0 0 0年 7～ 12月最高 ,分别高于 1999年同期 (P<0 .0 0 5 ) ;氨苄西林、哌拉西林的耐药率高达 6 4 %～ 83% ;(3)本组产 ESBL s大肠埃希氏菌阳性率 4 6 .3% (38/ 82 ) ,以创面分泌物中检出率最高 6 6 .7% (4/ 6 ) ,对头孢菌素类、氨苄西林、哌拉西林、环内沙星、妥布霉素、SMZ/ TMP呈多重耐药 ,耐药率 4 5 %～ 92 % ,显著高于非产 ESBL s大肠埃希氏菌 (P<0 .0 5～ 0 .0 0 5 ) ;对亚胺培南具有高敏感性。结论 本地区医院内大肠埃希氏?

Objectives To investigate the antibiotic resistance trend of clinical isolated Escherichia coli and the prevalence of part strains producing extended spectram β lactmase (ESBLs) in Qingyuan District from July, 1997 to December, 2000 and to guide the pharmacy in clinic. Methods The sensitivity of 361 Escherichia coli to 16 antibiotics was tested by MicroScan Auto Scan 4 and shifted the ESBLs producing strains to instrument expert system. Results (1) 361 Escherichia coli were tested from isolated 1555 of Gram negative bacillus from July, 1997 to December, 2000. The total positive rate was 23.2%. The positive rate in 2000 was significant higher than that in 1999 ( P <0.05～0.005); (2) Resistances to amikacin, aztreonam, cefoxitin, ceftazi dime, cefuroxime, ciprofloxacin and tobramycin was significantly different in each periods ( P <0.005). Resistances to aztreonam, cefoxitin, ceftazidime were the highest from July to December in 2000 and higher than that in the same periods in 1999 ( P <0.005). The resistance rates to ampicillin, piperacillin were in the range of 64%～83%; (3) The positive ESBLs producing Escherichia coli was 46.3% (38/82) in this period of time. The positive rate from the injured secretion 66.7% was the highest (4/6). The bacteria displayed multi drug resistance to cephalosporins, ampicillin, piperacillin, ciprofloxacin, tobramycin and sulfamethoxazole/trimethoprim. The range of resistance rate 45%～92% was significantly higher than that of non producing ESBLs Escherichia coli (P <0.05～0.005). The bacteria was highly sensitive to imipenem. Conclusions There was an increasing trend of hospital infection via Escherichia coli in this district. The positive rate of ESBLs producing Escherichia coli was high and multi drug resistance was serious, therefore testing bacteria drug sensitive expreriment before using medicine was needed.