2006~2009年间大肠埃希菌产超广谱β-内酰胺酶的检测和耐药性监测分析(1)
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【摘要】 目的 了解大肠埃希菌感染在我院重点病区的分布和产超广谱β-内酰胺酶(extended-spectrum β-lactamase,Esbls)的情况,监测、分析大肠埃希菌的耐药性,指导临床合理用药。方法 对2006~2009年间住院患者感染性标本分离的大肠埃希菌采用常规法或CNI系统鉴定,K-B法做药敏试验,用筛选试验和确证试验确认产ESBLS菌,并用WHOVET5.3和SPSS11.0软件进行分析。结果 共分离出大肠埃希菌456株,产ESBLS菌193株检出ESBLS(+)率42.3%。除对亚胺培南100%敏感外,产ESBLS菌的耐药性明显高于非产ESBLS菌株,特别是对第3代头孢菌素的耐药性二者相比差异有显著性(P>0.01)。病区分布情况从高到低依次为:ICU>呼吸内科>儿科>普外科等。从4年监测结果来看,大肠埃希菌产ESBLS(+)率有逐年增高趋势,且呈现多重和交叉耐药。结论 大肠埃希菌感染我院首位,阳性检出率逐年增高和第3代头孢菌素的大量应用情况基本一致,多重耐药菌的出现和广谱抗生素的不合理应用有一定关系。ICU、呼吸内科、儿科等病区患者出现尿路、呼吸道等系统感染时,应首先考虑为大肠埃希菌所致,应根据细菌培养和体外药敏试验及ESBLS菌的检测结果、合理使用抗生素、并动态监测药物耐药性变化,建立抗生素合理轮换使用制度,以防止产ESBLS耐药菌株的产生、扩散和流行。
【关键词】 埃希氏菌属;β-内酰胺酶类;抗药性,细菌;感染
2006~2009 years,Escherichia coli producing extended β-lactamase detection and monitoring of drug resistance
LI Jing-peng.Henan Province Shangqiu first People's Hospital nuclear medicine branch,Shangqiu 476100,China
【Abstract】 Objective To understand the key of E.coli infection in the hospital ward of the distribution and capacity for extended spectrum β-lactamases (extended-spectrum β-lactamase,Esbls) situation monitoring and analysis of drug resistance of Escherichia coli,clinical therapy.Methods Between 2006~2009 hospitalized patients infected Escherichia coli isolated from the conventional method or the CNI system identification,KB method for drug susceptibility testing,with the screening test and confirmatory test to confirm production ESBLS bacteria and SPSS11 with WHOVET5.3.0 software for analysis.Results A total of 456 E.coli isolated,193 strains producing ESBLS detection ESBLS (+) rate of 42.3%.In addition to 100%sensitive to imipenem,the resistance of bacteria producing ESBLS significantly higher than non-producing ESBLS strains,especially in the 3rd generation cephalosporin resistance in two significantly different compared (P>0.01).Ward distribution in the order of:ICU>Respiratory Medicine>Pediatrics>General Surgery etc..From 4-year monitoring results,E.coli producing ESBLS (+) rate has increased year by year,and presented a multi-and cross-resistance ......
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