239株革兰阴性杆菌超广谱β-内酰胺酶的检测及耐药性分析

Extended spectrum β-lactamases expression in 239 strains of Gram negative bacilli and their resistance to antibiotics.

检测超广谱β-内酰胺酶(extendedspectrumβ-lactamases,ESBLs)在革兰阴性杆菌中的表达及耐药特点,为临床积累经验。方法:应用双纸片协同试验和确证试验对239株革兰阴性杆菌进行ESBLs检测,同时分析药敏结果。结果:239株革兰阴性杆菌中ESBLs的检出率为20.5%(49/239),其中大肠埃希菌、肺炎克雷伯菌、其他菌种的检出率分别为23.3%(21/90)、33.3%(8/24)、16.0%(20/125)。产ESBLs的大肠埃希菌、肺炎克雷伯菌菌株对青霉素类、第三代头孢菌素、β-内酰胺酶抑制药、β-内酰胺类、氨基糖苷类的耐药率分别为100%,57%～95%、19%～71%、0～90%、38%～90%,其中耐药率最低的为β-内酰胺类的亚胺培南-西司他丁(0)、β-内酰胺酶抑制药的哌拉西林-三唑巴坦(19%)和氨基糖苷类的阿米卡星(38%)。结论:不仅大肠埃希菌和肺炎克雷伯菌可产ESBLs,其他革兰阴性杆菌也可产ESBLs;对产ESBLs的大肠埃希菌、肺炎克雷伯菌感染的治疗可首选亚胺培南-西司他丁。

Objective:To detect the expression of extended spectrum β lactamases (ESBLs) in Gram negative bacilli and bacterial drug resistance,so as to provide credible report of drug sensitivity. Methods:239 strains of Gram negative bacilli were detected by double disk synergy test and disc confirmatory test. Their sensitivity to antibiotics were analyzed. Results:There were 49 bacterial strains of ESBLs (+) in all 239 strains of Gram negative bacilli. The positive rate was 20.5%. The positive rates for E.coli. K.pneumonia and other bacteria of Enterobacteriaceae were 23.3%(21/90),33.3%(8/24) and 16.0%(20/125),respectively. The resistant rates of ESBLs (+) E.coli and K.pneumonia to penicillins,third generation of cephalothins,β lactamases inhibitor and other β lactamases were 100%,57%～95%,19%～71%,0～90%and 38%～90%respectively,with the lowest resistant rate in imipenem cilastatin (0),followed by β lactamases inhibitor piperacillin tazobactam (19%) and amikacin (38%). Conclusion:Not only E.coli. and K. pneumonia can produce ESBLs,other bacteria of Enterobacteriaceae can also produce ESBLs. Imipenem cilastatin is the best choice of drugs in treating infection of E.coli and K. pneumonia.