ICU与非ICU产AmpC酶阴沟肠杆菌的耐药性分析

Analysis of drug resistance of AmpC-producing Enterobacter cloacae in ICU and non-ICU

目的比较重症监护病房(ICU)与非ICU产AmpC酶阴沟肠杆菌的耐药性,了解临床产AmpC酶阴沟肠杆菌感染的药敏变化,为临床合理应用抗菌药物提供科学依据。方法对医院2009年1月-2012年12月临床标本中分离的产AmpC酶阴沟肠杆菌93株进行比较分析,用VITEK-32微生物分析系统进行病原菌鉴定,三维法检测AmpC酶,药敏试验K-B纸片法,数据采用SPSS19.0进行统计分析。结果共分离出产AmpC酶阴沟肠杆菌93株,其中ICU分离出21株占22.58%,其他科室72株占77.42%;其对头孢唑林、阿膜西林/克拉维酸、氨苄西林、氨苄西林/舒巴坦ICU和非ICU耐药率均达100.00%。结论产AmpC酶阴沟肠杆菌对抗菌药物耐药率明显高于非ICU,且呈多药耐药性,因此应加强监测临床感染菌的药敏变化,有针对性地选用敏感性强的抗菌药物,有效控制和减缓细菌耐药性的发生。

OBJECTIVE To compare the drug resistance of AmpC-producing E. cloacae in intensive care unit （ICU） and in non ICU, and understand the clinical changes of drug sensitivity of AmpC-producing E. cloacae, so as to provide a scientific basis for clinical rational application of antibiotics. METHODS Totally 93 strains of AmpC-pro- ducing Enterobacter cloacae isolated from clinical specimens in our hospital from Jan. 2009 to Dec. 2012 were compared and analyzed, the pathogenic bacteria were identified by VITEK-32 microbial analytical system, detection of AMPC enzyme was conducted with three-dimensional method, drug sensitive test with K-B disk diffusion method, data were analyzed by the software SPSS 19.0. RESULTS Totally 93 strains of AmpC-producing E. cloacae were isolated, including 21 （22.58%） in ICU and 72 （77.42%） in other departments. Their drug resistances in ICU and non ICU were all up tO 100.00% to cefazolin, amoxicillin/clavulanic acid, ampicillin and ampicillin/ sulbactam. CONCLUSION AmpC-producing E. cloacae isolated from ICU had significantly higher drug resistance than that from non ICU, and is present with multidrug resistance, therefore, it is suggested to strengthen monitoring of drug sensitivity changes, specificly select strongly sensitive antibiotics to effectively control and mitigate the occurrence of bacterial drug resistance.