AmpC酶在主要肠杆菌科和非发酵菌中的携带率及耐药性

Research on drug-resistance to antibiotics and schlepping rates of AmpC β-Lactamase in main enterobacteriaceae bacteria and non-ferment bacteria

目的 :调查主要肠杆菌科细菌和非发酵菌产AmpC酶和ESBLs的状况及对常用抗菌药物的耐药性 ,指导临床合理用药 .方法 :常规培养分离细菌 ,应用VITEK微生物自动分析仪和API鉴定系统鉴定病原菌 ;药敏试验采用K B纸片扩散法 ;AmpC酶检测采用三维试验法 ;ESBLs检测采用双纸片确认试验 .结果 :主要肠杆菌科细菌产AmpC酶和ESBLs的阳性率分别为 1 8.9% ,5 2 .8% ,其中以大肠杆菌、肺炎克雷伯、产酸克雷伯、阴沟肠杆菌为主 ,同时产 2种酶的菌株占1 5 .4 % ;绿脓杆菌产AmpC酶和ESBLs酶的阳性率分别为1 8.2 % ,4 2 .0 % ,同时产 2种酶的菌株占 1 3.6 % ;不动杆菌的产酶率均在 8.0 %以下 .产酶菌的耐药率高于非产酶菌 ,除绿脓杆菌外 ,产AmpC酶菌株的耐药率高于产ESBLs菌株 .主要肠杆菌科细菌对泰能 (IMP)的敏感性为 99.5 % ,而对舒普深 (CPZ)的耐药率平均为 1 3.8% ;非发酵菌对IMP ,马斯平(FEP)、CPZ的耐药率平均分别为 2 0 .4 % ,4 4 .3% ,1 8.6 % .结论 :主要肠杆菌科细菌的产酶率高于非发酵菌 ,产AmpC酶的菌株已近 2 0 .0 % ,应引起临床的高度重视 ;绿脓杆菌产ES BLs的菌株也较高 ,也应该加强监控 .对产酶菌引起感染的治疗应根据细菌药敏试验结果 ,合理选择有效的抗菌药物联合治疗 ;对重症感染患者的治疗应根据药?

AIM: To study the drug resistance to extended spectrum β Lactamase (ESBLs) and AmpCβ Lactamase (AmpC) produced from both the main enterobacteriaceae bacteria and non ferment bacteria. METHODS: All isolates were identified by routine procedure and pathogenic bacteria were identified by VITEK microbe automatic instrument and API identifying system. K B disk diffusion was used for anti microbial susceptibility test, AmpC was detected by three dimensional test and ESBLs was detected by double disk synergy test. RESULTS: From main enterobacteriaceae bacteria,the positive rates of the production of ESBLs and AmpC were 18.9% and 52.8%, respectively. Zymogenic bacteria were mainly represented by E.coli, K.pneumoniae, K.oxytoca and E.cloacae . The production rate of both ESBLs and AmpC simultaneously reached 15.4%. From P.aeruginosa , the positive rates of the production of ESBLs and AmpC were 18.2% and 42.0%, respectively. The production rate of both ESBLs and AmpC simultaneously reached 13.6%. Yet, from Acinetobacter, the zymogenic rate was below 8.0%. The drug resistance rates of zymogenic bacteria were higher than those of non zymogenic bacteria. The drug resistance rates of the production of AmpC bacteria were much higher than those of the production of ESBLs bacteria except for P.aeruginosa . Main Enterobacteriaceae bacteria ' sensitivity to Imipenem reached 99.5%, and the main Enterobacteriaceae bacteria ' average drug resistance rate to Cefoperazone was 13.8% . The average drug resistance rate of non ferment bacteria against Imipenem, Cefepime and Cefoperazone was 20.4%, 44.3% and 18.6% respectively. CONCLUSION: The zymogenic rates of main enterobacteriaceae bacteria are higher than those of non ferment bacteria. Nearly 20.0% of bacteria produced AmpC,to which intensive attention should be paid clinically. P.aeruginosa should also be under surveillance due to P.aeruginosa ' high ESBLS producing rate. The medicine for infections caused by zymogenic bacteria should be selected according to drug sensitive test results so as to choose rational and effective drugs. To severe infections, Imipenem and Cefoperazone are the best choice.