阴沟肠杆菌高产AmpC酶和ESBLs的检测及其多重耐药机制的研究

Detection of Enterobacter cloacae produced AmpC enzymes and ESBLs and study of its multi-drug resistance mechanism

目的探讨深圳地区多重耐药阴沟肠杆菌的流行状况及耐药机制。方法研究者对临床分离82株阴沟肠杆菌采用超广谱β-内酰胺酶(ESBLs)表型确证试验和氟氯西林(FCC)双抑制剂扩散协同试验法(DIDST)分别检测ESBLs、持续高产AmpC酶。结果从82株临床分离的阴沟肠杆菌中,检出33株(占40.2%)产去阻遏持续高产AmpC酶,25株(占30.5%)产ESBLs,14株(占17.1%)同时表达AmpC酶和ESBLs,10株(占12.2%)两种酶都不表达。结论高产AmpC酶和ESBLs是阴沟肠杆菌对头孢菌素耐药的主要机制,高产AmpC酶和ESBLs的产生与β酰胺类抗菌药物的广泛应用有着直接关系,临床治疗多重耐药阴沟肠杆菌应首选碳青霉烯类药物。

Objective To explore the prevalence and antimicrobial resistance mechanism of multiple drug resistance Enterobacter cloacae in ShenZhen region .Methods We screened 72 strains of multi resistant strains from 82 strains of Enterobacter cloacae iso‐lated from on clinical .And detected extended spectrum beta lactamases (ESBLs) and sustained high AmpC enzyme with ESBLs phenotypic confirmatory test and flucloxacillin (FCC ) double inhibitor diffusion synergy test method (DIDST ) .Results In 82 strains of Enterobacter cloacae isolated on clinical ,33 strains (40 .2% ) derepressed Hyperproducing AmpC enzymes ,25 strains (30 .5% ) produced ESBLs ,14 strains (17 .1% ) produced AmpC enzyme and ESBLs parallelly ,10 strains (12 .2% ) didn′t express the two enzymes .Conclusion High expression of AmpC enzyme and ESBLs is the main mechanism of cephalosporin resistant En‐terobacter cloacae .High AmpC enzyme and ESBLs production and widely used of beta amide antibacterial drug have a direct rela‐tionship .The first choice of treatment of multi drug resistant Enterobacter cloacae should be carbapenem .