同时产超广谱β-内酰胺酶和AmpCβ-内酰胺酶菌的单独和联合药物敏感分析

Antimicrobial Disk Susceptibility of Bacteria Producing Extended-spectrum β-Lactamases (ESBLs)+AmpC β-Lactamases (AmpCs) Alone and in Combination

目的 研究同时产超广谱β-内酰胺酶 (ESBL s)和 Am p Cβ-内酰胺酶 (Amp Cs)菌 (同产酶菌 )的抗生素单独和联合耐药性 ,以期指导同产酶菌的治疗。方法 采用多底物纸片法 (协同法、拮抗法 )、ESBL s确认试验、Am p Cs检测法检测 33株阴沟肠杆菌和 4 6株不动杆菌属的 ESBL s和 Amp Cs产酶情况 ,以琼脂扩散法检测同产酶菌的抗生素单独和联合耐药性。结果 在本组菌 ,检出同时产 ESBL s+Am p Cs产酶株 4 2株 ,其中 ESBL s+诱导型Amp Cs 12株 ,ESBL s+高产 Amp Cs 30株 ;同时产 ESBL s+诱导型 Amp Cs菌对亚胺培南、头孢吡肟和头孢哌酮 /他唑巴坦的单独敏感率均 >90 % ,对阿米卡星的敏感率为 6 6 .6 7% ,对其他 4大类 6种抗生素的单独敏感率均 <34% ;对 4大类 10种抗生素的 10种组合联合药敏 ,氨曲南与阿莫西林 /克拉维酸协同率高 (75 % ) ,亚胺培南与头孢哌酮 /他唑巴坦的拮抗率也较高 (5 0 % ) ,其余大部分为无关 ;在同时产 ESBL s+高产 Am p Cs时 ,有效抗菌药物仅为亚胺培南、头孢哌酮 /他唑巴坦 ,对其他 4大类 8种抗生素的单独敏感率均 <2 0 % ;对 4大类 10种抗生素的10种组合联合药敏 ,除氨曲南与阿莫西林 /克拉维酸有少量协同外 ,全部为无关。结论 阴沟肠杆菌和不动杆菌属的同产酶率很高 ;

OBJECTIVE To investigate the antimicrobial disk susceptibility of bacteria producing extended-spectrum β-lactamases (ESBLs)+AmpC β-lactamases (AmpCs) alone and in combination. METHODS To detect 33 strains of Enterobacter cloacae (Ecl) and 46 strains of Acinetobacter spp (Aci) with a multi-disk test [synergy test,antagonizing test for the inducible AmpC β-lactamases (IABLs)],AmpC β-lactamases (AmpCs) phenotype test and ESBLs confirmatory test,the susceptibility of antimicrobial agents alone and in combination with a diffusion method. RESULTS There were 42 strains produced ESBLs+AmpCs,12 strains producd ESBLs+high inducible AmpCs,30 strains produced ESBLs+high product AmpCs. Among the 12 strains produced ESBLs+high inducible AmpCs,the susceptibility to imipenem,cefepime and cefoperazone/sulbactam alone was more than 90%,to amikacin was 66.67%,to others (four classes) was no more than 34%;among 10 types of 10 classes of antimicrobial drugs in combination,the rates of synergy of aztreonam and amoxicillin/clavulanic acid were high (75%),the rates of resistance to imipenem and cefoperazone/sulbactam were high (50%),others were mainly without correlation. Among the 30 strains produced ESBLs+high product AmpCs,the susceptibility of imipenem and cefoperazone/sulbactam alone was more than 90% only,others (four classes) were no more than 20%;among 10 types of 10 classes of antimicrobial drugs in combination, the rates of synergy of amoxicillin/clavulanic acid were a lot,all others were without correlation. CONCLUSIONS The rates of producing ESBLs+AmpCs in Ecl and Aci are high;the bacteria producing ESBLs+AmpCs are only susceptible to imipenem and cefoperazone/sulbactam, among 10 types of 10 classes of antimicrobial drugs in combination,the rates of synergy are a lot,others are mainly without correlation.