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

Clinical distribution and drug resistance of extended spectrum beta lactamases producing Escherichia coli in cancer patients

目的 对肿瘤患者产超广谱β-内酰胺酶大肠埃希菌的临床分布及耐药性进行深入分析，提高临床上抗菌药物使用的正确性。 方法 本研究于2017年5月至2018年5月随机选取了院内接受治疗的肿瘤患者的尿液、引流液、血液、分泌物、痰液以及穿刺液作为标本，通过双纸片协同试验的方式，对超广谱β-内酰胺酶进行筛选。 结果 超广谱β-内酰胺酶大肠埃希菌的科室分布以泌尿外最多，占比为28.70%，肝胆外科次之，占比为11.88%，其余科室占比均不超过10%；尿液是超广谱β-内酰胺酶大肠埃希菌的主要来源，占比为 55.36 %；穿刺液分泌物次之，占比分别为15.36%、14.49%；头孢唑啉、头孢哌酮、头孢呋辛、头孢噻肟、哌拉西林、氨苄西林的耐药率最高，均达到了100%，其次是复方磺胺甲噁唑，耐药率为78.26%，而亚胺培南的耐药率为0%。 结论 超广谱β-内酰胺酶大肠埃希菌的耐药性已经很高，在临床上必须要按照药敏试验的结果以及微生物检验结果科学的使用抗菌药物，同时强化对于超广谱β-内酰胺酶大肠埃希菌耐药性与感染率的检查与管理，在临床上也应对超广谱抗菌药物的使用进行有效限制。

Objective ： to analyze the clinical distribution and drug resistance of isoflavinase isoechinococcus aureus in patients with tumor by ultra-broad spectrum and to improve the accuracy of clinical use of antimicrobial drugs. Methods： this research in May 2017 to May 2018 randomly selected from the hospital for treatment,drainage of liquid,the urine of patients with tumor blood,secretions,sputum and puncture fluid as a specimen,by means of double paper synergy test,the ultra broad spectrum beta lactamase screening. Results： the distribution of superbroad-spectrum electron-lactamase escherichia coli was the highest,accounting for 28.70%,followed by hepatobiliary surgery,accounting for 11.88%,and no more than 10% in other departments.Urine is the main source of isoflavase isozyme escherichia coli,accounting for 55.36%.Puncture fluid secretion was second,accounting for 15.36% and 14.49% respectively.Cefazolin,cefoperazone,cefuroxime,cefotaxime,piperacillin,ampicillin,the highest percentages of all reached 100%,the second is the compound sulfamethoxazole,ni is 78.26%,and imide culture south of the resistant rate of 0%. Conclusion ： the ultra broad spectrum beta lactamase e.coli resistance is high,must be in accordance with the results of drug sensitive test in clinic and microorganism inspection results scientific use of antimicrobial agents,at the same time strengthening for ultra broad spectrum beta lactamase e.coli resistance and infection rate of inspection and management,in clinic should also effectively limit the use of antibacterial drugs.