尿路感染患者产超广谱β-内酰胺酶大肠埃希菌的耐药性分析

Drug resistance analysis of extended-spectrum β-lactamase-producing E. coli causing urinary tract infections

目的了解尿路感染患者中产超广谱β-内酰胺酶(extended-spectrumβ-lactamase,ESBLs)大肠埃希菌的耐药现状,指导临床合理用药。方法从我院2015年1月—2016年1月间尿路感染患者的尿液中分离出大肠埃希菌株。所有菌株采用法国梅里埃公司VITEK2 Compact分析仪进行细菌鉴定,纸片扩散法检测大肠埃希菌产ESBLs的产生情况及耐药特点。结果从尿路感染患者中共检出大肠埃希菌432株,其中有226株产ESBLs,检出率为52.31%,药物敏感性试验结果显示产ESBLs菌株对亚胺培南耐药率仅为0.88%;其次为呋喃妥因,耐药率为19.91%;耐药率最高的为氨苄西林,为98.23%;对含酶抑制剂的药物其耐药率也明显增加。与非产ESBLs菌株耐药性相比,产ESBLs株的耐药率显著增高。结论尿路感染患者中分离得到产ESBLs大肠埃希菌的比例较高,积极检测和监测产ESBLs大肠埃希菌及其耐药情况对于临床合理用药、院内感染控制及流行病学调查极为重要。

Objective To investigate the drug resistance of extended-spectrum β-lactamase（ESBLs）-producing E. coli isolated from patients with urinary tract infections and provide guidance for rational use of antibiotics. Methods All E. coli strains were isolated from patients with urinary tract infection in our hospital from January 2015 to January 2016. Bacterial identification was used with VITEK2 bio Merieux（France）. The conformation of ESBLs and drug resistance were detected with Kirby-Bauer method. Results A total of 432 E. coli strains were isolated from patients with urinary tract infections, 226 isolates produced ESBLs, the detection rate was 52.31%. The drug sensitivity analysis showed resistant rate of meropenem to ESBLs producing strains was only 0.88%, then nitrofurantoin with 19.91%, and the highest ampicillin was 98.23%. In addition, the resistant rates for antibiotics containing enzyme inhibitors were also significantly higher. Compared with the non ESBLs producing strains, the resistant rates of the ESBLs producing strains were significantly increased. Conclusions For the high prevalence of ESBL-producing E. coli isolated from patients with urinary tract infections, the detection and surveillance of ESBLs for E. coli are essentially important for initiate appropriate therapies in clinical practice, infection control and epidemiological surveillance.