近3年分离大肠埃希菌耐药性的分析

Analysis of drug resistance of Escherichia coli isolated in the recent three years

目的了解我院2014年1月1日—2016年12月31日3年间分离的1584株大肠埃希菌耐药性,指导临床用药。方法常规培养分离细菌,用法国梅里埃Vitek2-Compact T全自动鉴定药敏分析仪及配套试剂。结果 1584株大肠埃希菌中来自尿液710株(44.8%);血液197株(12.4%);分泌物193株(12.1%);痰液169株(10.6%);胸腹水30株(1.9%)。其科室分布列前3位的分别为:泌尿外科326株(22.4%);肾内科180株(11.4%);重症监护室(ICU)165株(10.4%)。3年间产ESBLs大肠埃希菌的检出率分别为63.9%、58.7%和60.5%。产ESBLs大肠埃希菌对大多数抗菌药物的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,2016年发现3株对亚胺培南耐药的大肠埃希菌。结论产ESBLs大肠埃希菌对绝大部分抗生素的耐药率居高不下,应密切关注大肠埃希菌耐药性变迁,防止多重耐药菌株的传播流行。

Objective To understand the Escherichia coli bacterium distribution and the trend of antibiotic resistance in our hospital from 2014 to 2016, and guide clinical medication. Methods Conventional culture and isolation of bacteria, with the VITEK2-COMPACT analysis system were used for the identification of strains and drug susceptibility test. Results Among 1584 strains of Escherichia coli isolates, there were 710 （44.8%） from urine, 197 （12.4%） strains from blood, 193 （12.1%） strains from secretions, 169 （10.6%） strains from sputum, and 30 （1.6%） strains from pleural effusion and ascites. The Escherichia coli strains mainly distributed in the departments including pediatric thoracic surgery （326 strains, 22.4%）, the renal medicine （180 strains, 11.4%）, and ICU （165 strains, 10.4%）. During the three years, the detection rates of ESBL-producing Escherichia coli were 63.9%, 58.7%, and 60.5%, respectively. The drug resistant rates were significantly higher than those of the non-ESBL-producing Escherichia coli （P〈0.01）. Three strains of Escherichia coli were identified as resistant strains against imipenem in 2016. Conclusion The detection rate of ESBL-producing Escherichia coli and for the vast majority of antibiotic resistance rate were maintained at high levels. The first choice for the treatment of ESBL-producing Escherichia coli infections is enzyme inhibitors and cephamycins combined with amikacin. For severe infections, carbapenem drugs can be used.