血液感染大肠埃希菌的耐药性及其产超广谱β-内酰胺酶分析

Analysis of the drug resistance and the extended spectrum beta-lactamases in Escherichia coli from blood

目的分析2005～2007年三年间住院病人血液中大肠埃希菌对常用抗菌药物的耐药性及其产超广谱β-内酰胺酶(ES-BLs)情况,为临床合理用药提供依据。方法Bact/ALERT3D血培养仪进行血液培养,VITEK-60系统、GNI+卡、GNS-143卡进行菌种鉴定、ESBLs检测和药敏试验。结果三年间送检的9513份血培养标本中,检出132株大肠埃希菌,其中产ESBLs菌株67株,检出率50.76%;产ESBLs菌株的耐药率明显高于非产ESBLs菌,其对β-内酶胺类药物100%耐药,对喹诺酮类、磺胺类药物耐药性高,对哌拉西林/他唑巴坦、呋喃妥因耐药率分别为6.0%,9.0%;所有受试菌对亚胺培南均敏感。结论血液中感染大肠埃希菌对常用抗菌药物的耐药性日益严重,产ESBLs菌株的检出率高,要重视ESBLs的检测,治疗时应根据药敏结果选择抗菌药物。

Objective To analyze the infection rate,drug resistance of the Escherichia coli and the ESBLs-producing strains in blood of the hospital patients from 2005 to 2007 and to provide the reference for clinical antimicrobial usage.Methods Blood was cultured with BacT/ALERT 3D,antimicrobial susceptibility tests and ESBLs-producing were detected with Vitek-60,GNI+,and GNS-143.Results 132 strains of Escherichia coli were detected from the 9513 samples,with 67 ESBLs-producing strain,the detection rate of ESBLs-producing strain among 132 strains of Escherichia coli was 50.76%. The antimicrobial resistance rate of ESBLs-producing strains to many antimicrobial agents were much higher than that of non-ESBLs-producing strains. The resistance rate of ESBLs-producing strains to β-lactam antimicrobial agents was 100%,and resistant rates to quinolones,aminoglycosides and sulfonamides were all very high. The resistance rates to cefotetan,piperacillin/tazobactam were 6.0%,9.0% respectively,all strains were susceptible to imipenem.Conclusion Drug resistance of Escherichia coli in blood become more and more serious,the detection rate of ESBLs-producing strains was high,clinical treatment should choose antimicrobial agents according to antimicrobial susceptibility tests and ESBLs detection.