314株铜绿假单胞菌超广谱β-内酰胺酶及AmpC酶的分布及多药耐药性分析

Extended-spectrum Beta-lactamases and AmpC Enzymes of 314 Strains Pseudomonas aeruginosa:Their Distribution and Multidrug-resistant Analysis

目的了解我院2012年铜绿假单胞菌超广谱β-内酰胺酶(ESBLs)和头孢菌素酶(AmpC酶)在感染中的流行情况及耐药特征,为临床合理使用抗生素提供实验室依据。方法细菌鉴定采用法国生物梅里埃公司VITEK2-compact的GN鉴定卡;药敏试验采用K-B扩散法;双纸片增效法检测ESBLs;头孢西丁三维实验法检测AmpC酶;应用Whonet5.4、SPSS13.0软件进行统计分析。结果在2113份阳性标本中分离出铜绿假单胞菌314株为14.9%,其中呼吸道标本的阳性率最高为78.0%,以呼吸内科、老年病科及ICU病房检出率为主,分别为22.6%、19.4%、18.5%。单产AmpC酶、单产ESBLs及同时产AmpC酶+ESBLs的铜绿假单胞菌分别为81株、56株、56株,其中ICU产酶率最高,其次为呼吸内科及老年病科,产酶率分别占79.3%、71.8%、70.5%。铜绿假单胞菌对美罗培南,阿米卡星及亚胺培南耐药性最低,分别为15.3%、19.7%、25.8%。结论产酶的铜绿假单胞菌多药耐药严重,合理使用抗生素以减少耐药率。

Objective To investigate the prevalence of strains producing extended-spectrum β-lactamases （ESBLs） and AmpCβ-lactamases in Pseudomonas aeruginosa in our hospital from 2012,and to supply the laboratory evidence for antibiotic rational application in clinic.Methods The bacterial identification was performed by using the GN identifica-tion card of VITEK2-Compact automatic instrument from French Bio-Merieux.Kirby-Bauer method was employed to carry out the antimicrobial susceptibility testing.ESBLs were detected by synergistic test,and cefoxitin three dimen-sional test was applied to filter AmpC positive strains.The statistical analysis was performed with Whonet 5.4 and SPSS 13.0 softwares.Results A total of 314 strains of Pseudomonas aeruginosa were isolated from 2113 positive sam-ples,with the detection rate of 14.9%.Among them respiratory specimen has the highest positive rate was 78.0%.The detection rate of the strains was 22.6% in the deparment of respiratory medicine,19.4% in the department of geriat-rics,and 12.0% in ICU.Among 314 strains of Pseudomonas aeruginosa,81 strains were AmpC enzymes positive,56 strains were ESBLs positive,and 56 were AmpC＋ESBLs.The ICU enzyme production rate is the highest,followed by breaching internal medicine and geriatrics,enzyme production rate accounted for 79.3%,71.8% and 70.5%,respective-ly.The drug resistance rates of the Pseudomonas aeruginosa strains to meropenem,amikacin,And imipenem were 15.3%,19.7%,and25.8%,respectively.Conclusions Enzyme production of Pseudomonas aeruginosa is serious,rea-sonable use of antibiotic to reduce resistance.