某县级医院2012—2014年不同临床标本分离大肠埃希菌ESBLs检出率及其耐药性

Detection of extended-spectrum β-lactamases and antimicrobial resistance of Escherichia coli isolated from different clinical specimens of a county hospital in 2012-2014

目的分析某山区县级医院大肠埃希菌临床感染分布及耐药性,为该区域临床合理治疗大肠埃希菌感染提供依据。方法对2012—2014年某院临床送检的各类标本进行细菌培养、菌株鉴定与药敏试验,超广谱β-内酰胺酶(ESBLs)检测用微量稀释法初筛,纸片扩散法做确证试验;采用WHONET5.6及SPSS19.0软件对数据进行统计分析。结果271株大肠埃希菌,主要分离自中段尿(占26.94%)。产ESBLs大肠埃希菌检出率为49.82%,以痰标本检出率最高(56.52%),但不同标本分离的大肠埃希菌中产ESBLs菌株检出率比较,差异无统计学意义(P>0.05)。药敏结果显示,对青霉素类耐药率最高(>90%),对头孢噻吩和头孢呋辛的耐药率>75%,对阿米卡星和哌拉西林/他唑巴坦敏感性较好(耐药率<10%),未发现对碳青霉烯类抗生素耐药的大肠埃希菌,产ESBLs株对大多数抗菌药物的耐药率高于非产ESBLs株。结论分离大肠埃希菌的标本主要来自中段尿,产ESBLs菌株耐药性更高。

Objective To analyze the distribution and antimicrobial resistance of Escherichia coli（E.coli）causing infection in a county hospital,and provide basis for clinical treatment of E.coli infection.Methods From2012 to2014,all kinds of clinical specimens in a hospital were performed bacterial culture,identification,and antimicrobial susceptibility testing;extended-spectrumβ-lactamases（ESBLs）were initially screened by broth microdilution method,and confirmed by disc diffusion method;data were statistically analyzed by WHONET5.6 and SPSS19.0software.Results 271 isolates of E.coli were detected,and mainly isolated from midstream urine（26.94%）.The detection rate of ESBLs-producing E.coli was 49.82%,most were isolated from sputum specimens（56.52%）,but there was no significant difference in detection rates of ESBLs-producing E.coli isolated from different specimens（P〈0.05）.Antimicrobial susceptibility testing results showed that the resistance rate of E.coli to penicillins was the highest（90%）,to cefalotin and cefuroxime were both 75%,susceptibility rates to amikacin and piperacillin/tazobactam were both high（resistance rates10%）,carbapenem-resistant strain was not found,resistance rates of ESBLs-producing strains to most antimicrobial agents were significantly higher than non-ESBLsproducing strains.Conclusion E.coli is mainly isolated from midstream urine specimens,antimicrobial resistance of ESBL-producing strains is more serious.