脑膜败血伊丽莎白菌耐药性和耐药表型研究

Analysis of drug resistance and resistance phenotypes of Elizabethkingia meningoseptica

目的了解临床分离脑膜败血伊丽莎白菌(EME)的耐药率并进行耐药表型分析。方法采用微量肉汤稀释法(MIC)和KB法检测30株EME对22种抗菌药物的耐药率,用纸片法、改良三维试验法进行超广谱β-内酰胺酶(ESBLs)、头孢菌素酶(Ampc)和金属β-内酰胺酶(MBL)的表型确证试验。结果 30株EME对所有β-内酰胺类药物的耐药率达70%以上,而对环丙沙星和左氧氟沙星及含酶抑制剂的哌拉西林/他唑巴坦和头孢哌酮/舒巴坦有较好的敏感性。对万古霉素和利福平耐药率分别为23.3%和16.7%。所有菌株均检出ESBLs而未检出Ampc,18株(60.0%)细菌检出产MBL。结论 EME是多药耐药的细菌,产ESBLs和MBL,其中ESBLs对β-内酰胺类药物的耐药起主要作用。临床常用于治疗革兰阴性杆菌的亚胺培南和美罗培南对EME效果差,而用于治疗革兰阳性球菌的万古霉素和利福平对该菌有治疗活性,复方新诺明、米诺环素、含酶抑制剂类、氟喹喏酮类药物是治疗的首选。

Objective To investigate drug resistance and resistance phenotypes of Elizabethkingia meningo-septica（EME）.Methods The drug resistance rates of 30 strains to 22 antibiotics were detected by MIC and disk dilu-tion method.Phenotypes of extended spectrum β-lactamase（ESBLs）, Ampc and metallo β-lactamase（MBL） were de-tected by disk diffusion and modified three dimension test .Results The drug resistance rates of 30 strains toβ-lactam grop drugs were above 70%, all strains were more susceptible to trimethoprim-sulfa（SXT）, ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefoperazone/sulbactam.The drug resistance rates to vancomycin and rifampi were 23.3%and 16.7%respectively.All the isolates were detected to have ESBLs but no Ampc , 18 strains（60.0%） had MBL.Con-clusion EME was multi-drug resistance , it can produce ESBLs and MBL .While ESBLs was most responsible for the resistance to β-lactam group drugs .EME was more resistance to imipenem and meropenem which were used to cure most of the gram negative bacilli , but more susceptible to vancomycin and rifampin which were used to cure most of the gram positive coccus.SXT, minocycline,β-lactamase inhibitor and quinolones drugs may be the best choice for its in-fection.