临床分离大肠埃希菌的分布特征及耐药性

Distribution of clinical isolates of Escherichia coli and drug resistance

目的了解聊城地区临床分离大肠埃希菌的分布特征及其在不同科室的耐药性,为临床医师合理使用抗菌药物提供科学依据。方法对288株大肠埃希菌的标本来源进行回顾调查分析,采用Vitek2-compact全自动微生物鉴定系统进行细菌鉴定,药敏试验采用K-B纸片扩散法。结果 288株大肠埃希菌来自痰91株(31.6%),其次为尿81株(28.1%)、脓液42株(14.6%);从科室分布来看,主要分布于外科102株(35.4%)、内科90株(31.3%)、ICU70株(24.3%)。检出产超广谱β-内酰胺酶(ESBLs)175株,检出率为60.8%。产ESBLs和非产ESBLs菌株的耐药率除亚胺培南、阿米卡星、呋喃妥因和复方新诺明外差异均有统计学意义(P<0.05)。亚胺培南在所有科室的耐药率均较低。结论大肠埃希菌产ESBLs呈上升趋势,各科室要根据实际情况合理应用抗生素,防止医源性传播。

Objective To investigate the distribution of clinical Escherichia coli（E.coli） isolates and the resistance in diferent departments,so as to provide scientific basis for the clinical rational use of medication.Methods A retrospective review was performed to analyze the clinical distribution of 288 isolates of E.coli.The strains were identified by the automatic microorganism analyzer VITEK2-compact.Bacteria＇s drug susceptibility was performed by K-B method.Results Totally 91 strains of E.coli were isolated from respiratory secretions（31.6%）,followed by urine and pus,were 81strains（28.1%）,42 strains（14.6%）;from the distribution of departments,mainly distributed in the chirurgery,internal medicine and ICU,were 102strains（35.4%）,90 strains（31.3%） and 70 strains（24.3%）.175 strains out of 288 strains of E.coli,the detection rates of ESBLs-producing E.coli was 60.8%.There was a statisitical difference between ESBLs-producing strains and non-producing ESBLs strain except imipenem,amikacin,nitrofurantoin and thoprim/sulfa（P 0.05）.Imipenem was very low in all departments.Conclusion The producing rate of ESBLs is increasing gradually.It is essential to reasonable use of antibiotics based on the actual situation in clinical,meanwhile,strengthen the drug resistance determination of producing ESBLs in order to control E.coli iatrogenic infections.