碳青霉烯类非敏感肠杆菌科细菌的β-内酰胺酶检测及耐药性分析

目的：探讨碳青霉烯类非敏感肠杆菌科细菌产碳青霉烯酶、超广谱β-内酰胺酶（ESBLs）及对16种抗菌药物的耐药情况，为临床合理用药提供依据。方法收集2010年1月至2013年12月临床分离的对碳青霉烯类非敏感的肺炎克雷伯菌214株、大肠埃希菌111株，采用改良Hodge试验对碳青霉烯酶进行检测，表型确证试验检测ESBLs，K-B纸片扩散法检测药敏试验。结果214株肺炎克雷伯菌单产碳青霉烯酶的阳性率为57.9%，单产ESBLs为12.6%，同时产ESBLs和碳青霉烯酶为20.6%；111株大肠埃希菌单产碳青霉烯酶的阳性率为54.1%，单产ESBLs为5.4%，同时产ESBLs和碳青霉烯酶为23.4%。试验菌株对临床常用的抗菌药物耐药性严重，耐药率在13.5%-98.1%之间，对米诺环素和替加环素耐药率低。结论对碳青霉烯类非敏感的肺炎克雷伯菌和大肠埃希菌产碳青霉烯酶率高，治疗该类细菌引起的感染可根据病原菌药敏试验结果和患者病情合理选用替加环素或米诺环素，以达到有效控制感染目的。

Objective To evaluate the production of carbapenemase、extended spectrum Beta-Lactamases（ESBLS）of carbapenems non-susceptible enterobacteriaceae and analyze the drug resistance to sixteen common antibiotics,so that to guide the appropriate selection of initial empiric regimens and drugs used for individual patients in specific situations. Methods 214 strains of carbapenems non-susceptible Klebsiella pneumoniae and 111 strains of Escherichia coli were isolated in our hospital from Jan 2010 to Dec 2013. Modified Hodge test was used to detect carbapenemase. ESBLS was detected by Phenotype confirmatory test. The drug susceptibility test was performed by disk diffusion method. Results The positive rate of carbapenemase in Klebsiella pneumoniae and Escherichia coli was 57.9%and 54.1%,while ELBLs positive rate was 12.6%and 5.4%respectively. 20.6%of Klebsiella pneumoniae and 23.4%of Escherichia coli had both carbapenemase and ESBLs. Test stains have serious resistance to the clinical common used drugs and high susceptible to minocyline and tigecycline. Conclusion The positive rate of carbapenemase is high in carbapenems non-susceptible Klebsiella pneumoniae and Escherichia coli. Minocyline and tigecycline will be most useful as empirical therapy for the infections caused by carbapenems non-susceptible Enterobacteriaceae.