糖尿病足患者铜绿假单胞菌的耐药性及产超广谱β-内酰胺酶检测

Drug resistance and extended spectrum β-lactamase detection of pseudomonas aeruginosa in the patients with diabetic foot

目的探讨感染糖尿病足(DF)患者铜绿假单胞菌的耐药情况和产超广谱β-内酰胺酶(ESBLs)情况。方法采用全自动微生物分析仪鉴定铜绿假单胞菌,琼脂稀释法检测抗菌药物敏感性,双纸片协同法检测铜绿假单胞菌产ESBLs情况,分析浅部与深部溃疡的铜绿假单胞菌产ESBLs及耐药性。结果 80株铜绿假单胞菌中,33株(41.25%)是多重耐药菌,30株(37.50%)是产ESBLs,在产ESBLs铜绿假单胞菌中90.0%(27/30)为多重耐药菌。头孢他啶、环丙沙星和阿奇霉素在多重耐药组的耐药率明显高于耐药组(P<0.05);头孢他啶、环丙沙星和复方新诺明在ESBLs阳性组的耐药率明显高于ESBLs阴性组(P<0.05);深部溃疡的多重耐药菌比率、产ESBLs比率和既是产ESBLs菌又是多重耐药菌比率均明显高于浅部溃疡(P<0.05)。结论感染DF患者铜绿假单胞菌的耐药形势不容乐观,其中产ESBLs和来源于深部溃疡铜绿假单胞菌的耐药形势更加严峻。

Objective To investigate the drug resistance and detection of extended spectrum β-lactamase （ESBLs） of pseudomonas aeruginosa in the patients with diabetic foot （DF）. Methods Pseudomonas aeruginosa was identified by a full automatic microbiological analysis. The antimicrobial susceptibility was detected by agar dilution method. ESBLs in pseudomonas aeruginosa were detected by double disc synergy method. The ESBLs and drug resistance of pseudomonas aeruginosa in superficial ulcer and deep ulcer were analyzed. Results Of eighty strains of pseudomonas aeruginosa isolated, including 33 strains （41.25%） were multi-drug resistant bacteria, and 30 strains （37.50%） produced ESBLs, of which 27 strains （90%） were multi-drug resistant bacteria. The resistant rate to ceftazidime, ciprofloxacin and azithromycin in Multi- Drug Resistant Group was significantly higher than that in Drug Resistant Group （P〈0.05）. The resistant rate to ceftazidime, ciprofloxacin and compound sulfamethoxazole tablets in ESBLs-Positive Group was significantly higher than that in ESBLs- Negative Group （P〈0.05）. The proportion of multi-drug resistant bacteria, ESBLs-Positive and both the production of ESBLs and multi-drug resistant bacteria in the patients with .deep ulcer was significantly higher than that in the patients with superficial ulcer （P〈0.05）. Conclusion The drug resistance of pseudomonas aeruginosa in patients with DF is far from optimistic, and that of the ESBLs-positive pseudomonas aeruginosa and pseudomonas aeruginosa from deep ulcers are more severe.