革兰阴性菌对头孢替坦的耐药性分析

Analysis on drug resistance of gram-negative bacilli to cefotetan

目的了解临床分离革兰阴性菌对头孢替坦的耐药性。方法收集2012年1月至2013年6月从医院各种临床标本中分离的革兰阴性菌,使用VITEK2-compact微生物全自动分析仪进行鉴定和药敏试验,对结果进行回顾性调查。结果分离出革兰阴性菌1 045株,其中肠杆菌科细菌627株,占60.0%;非发酵菌402株,占38.5%。分离前3位的细菌分别为大肠埃希菌(27.7%)、铜绿假单胞菌(20.2%)、肺炎克雷伯菌(14.5%)。肠杆菌科细菌对头孢替坦耐药率低,53.3%的大肠埃希菌和29.6%的肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)、产ESBLs大肠埃希菌和肺炎克雷伯菌对头孢替坦耐药率均低于6.0%。非发酵菌中铜绿假单胞菌和鲍曼不动杆菌对头孢替坦的耐药率均高于90.0%。结论头孢替坦可以作为临床治疗产ESBLs细菌感染性疾病的一种经验性治疗方案。

Objective To investigate the clinical isolates of gram-negative bacilli to cefotetan resistance.Methods Gramnegative bacilli were isolated from various clinical specimens in our hospital from Jan 2012 to June 2013.The identification and antimicrobial susceptibility testing of the isolates were determined by VITEK2-compact Full Automated Microbiology Analyzer.Results A total of 1 045 strains of gram-negative bacilli were isolated.In which,627 isolates were Enterobacteriaceae and 402 isolates were non-fermenters,accounted for 60.0% and 38.5%,respectively.The most predominant pathogens were Escherichia coli（27.7%）,Pseudomonas aeruginosa（20.2%） and Klebsiella pneumoniae（14.5%）.The resistant rate of Enterobacteriaceae bacteria to cefotetan was low. 53.3% Klebsiella pneumoniae and 29.6%Escherichia coli could produce the extended-spectrum beta-lactamases（ESBLs）; the resistant rates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae to cefotetan were both less than 6.0%.The resistant rates of Pseudomonas aeruginosa and Acinetobacter bauman to cefotetan were both higher than 90.0%. Conclusion Cefotetan can be used as an empirical treatment of infectious diseases causing by ESBLs-producing bacteria.