肿瘤患者产超广谱β-内酰胺酶大肠埃希菌的临床分布及耐药性分析

Distribution and drug resistance of Escherichia coli producing extended-spectrumβlactamases in cancer patient

目的分析该院2013年分离的产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的临床分布、标本类型及对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供参考。方法回顾性分析375株产ESBLs的大肠埃希菌的临床分布及耐药性,用纸片扩散法表型确证试验检测ESBLs。结果科室分布以妇科最多,占42.67%,其次为泌尿外科(14.67%);标本类型中尿液为最多(55.2%),其次为穿刺液(15.47%)和分泌物(14.67%);耐药分析发现产ESBLs的大肠埃希菌对头孢唑啉、头孢呋辛、头孢哌酮、头孢噻肟的耐药率均为100.00%,对复方磺胺甲噁唑的耐药率为78.10%,而对亚胺培南为0.00%,阿米卡星为4.30%,磷霉素为10.10%。该院产ESBLs的大肠埃希菌对哌拉西林/他唑巴坦、氨曲南的耐药率分别为17.10%和66.70%。结论产ESBLs大肠埃希菌的耐药情况已经非常严重,临床应根据药敏结果合理应用抗菌药物,并加强对产ESBLs大肠埃希菌感染率和耐药性的监测。

Objective To study the distribution,specimen types and characteristics of antibiotic resistance of Escherichia coli producing extended-spectrumβlactamases（ESBLs）of the hospital in 2013 and to guide clinical drug use.Methods Analyzed the distribution and antibiotic resistance for the 375 strains of ESBLs-producing E.coli,and ESBLs was detected by disk diffusion phenotypic confirmatory test.Results The major distribution department was gynecology department which accounted for 42.67%,followed by uropoiesis surgical department which accounted for 14.67%;the major specimen type was urine（55.2%）,followed by puncture fluid（15.47%）and excretion（14.67%）.For the 375 isolates of ESBLs-producing E.coli,the resistance rates to cefazolin,cefuroxime,cefoperazone and cefotaxime were 100.00%,to SMZco was 78.10%,while the resistance rate to imipenem was 0.00%,and to amikacin and fosfomycin were 4.30% and 10.10%respectvely,the resistance rates to piperacillin/tazobactam and aztreonam were 17.10% and 66.70%respectvely.Conclusion ESBLs producing Escherichia coli have severe multidrug resistance.Antibiotics should be chosen and used rationally in accordance with results of drug susceptibility testing,meanwhile the monitoring of ESBLs′infection rate and drug resistance should be strengthened.