连续5年临床分离大肠埃希菌耐药性的变迁

Analysis of changes in drug resistance of Escherichia coli in five consecutive years

目的了解医院2008-2012年分离的大肠埃希菌耐药性变迁,以指导临床用药。方法收集2008-2012年医院临床送检的痰液、尿液、分泌物、血液、胸腹水、胆汁等标本中经分离鉴定的大肠埃希菌1 742株,采用美国DADE BEHRING MicroScan分析系统和VITEK-2Compact鉴定菌种,K-B纸片法进行药敏试验,数据采用SPSS 13.0统计软件进行分析。结果 1 742株大肠埃希菌分离自尿液954株、痰液361株、分泌物173株、血液112株、胸腹水66株,分别占51.6%、19.5%、9.4%、6.1%、3.6%;其科室分布列前3位的依次为肾内科344株、儿科232株、泌尿外科198株,分别占19.7%、13.3%、11.4%;5年间产ESBLs大肠埃希菌的检出率分别为47.7%、40.5%、48.4%、63.2%和53.9%;产ESBLs大肠埃希菌耐药率明显高于非产ESBLs大肠埃希菌,其对临床常用抗菌药物的耐药率呈逐年上升趋势,未发现耐亚胺培南大肠埃希菌。结论产ESBLs大肠埃希菌对绝大部分抗菌药物的耐药率维持在较高水平,应加强大肠埃希菌耐药性监测,了解其变迁,指导临床合理用药,防止耐药菌株的传播。

OBJECTIVE To understand the changes in antibiotic resistance of Escherichia coli isolated in the hospital from the year 2008 to 2012 so as to guide clinical medication. METHODS Totally 1742 strains of E. coli were isolated and identified from specimens of sputum, urine, secretions, blood, pleural effusion and ascites% and bile collected from 2008 to 2012. The strains were identified by the United States DADE BEHRING MicroScan analysis system and VITEK-2 Compact. The K-B disk method was used for drug susceptibility test. The software SPSS 13.0 was used for statistical analysis. RESULTS Among the 1742 strains of E. coli isolates, 954 strains （51.6%） were from urine, 361 strains from sputum （19.5%）, 173 strains （9.4%） from secretions, 112 strains （6.1%） from blood, 66 strains （3. 6%） from pleural effusion and ascites. The top three departments where strains mainly distributed were the urology department （344 strains, 19. 7%）, the pediatric department （232 strains, 13.3%） and the department of urinary surgery （198 strains, 11.4%）. The detection rate of ESBLs- producing E. coli in the 5 years was 47.7%, 40.5%, 48.4%, 63.2%, and 53.9% respectively. Compared to non ESBLs-producing E. coli, ESBLs-producing E. coli had higher resistance rate which was increasing year by year. No imipenem-resistant E. coli were found. CONCLUSION The antibiotic resistance rate of ESBLs-producing E. coli remains at a high level. Clinicians should enhance the monitoring of resistance of E. coli, and understand its changes to guide clinical rational drug use and prevent cross-strain transmission.