179株大肠埃希菌产ESBLs和AmpC酶的检测及耐药性分析
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摘要
目的探讨临床分离的大肠埃希菌产ESBLs和AmpC酶情况及其耐药性,为临床合理使用抗菌药物提供实验依据。方法细菌鉴定采用美国BD公司Phoemix100微生物分析仪鉴定;药敏试验采用K-B纸片扩散法;按CLSI推荐的确证试验检测ESBLs;产AmpC酶初筛试验采用头孢西丁纸片扩散法,确证试验采用三维试验。结果 179株大肠埃希菌产ESBLs和AmpC酶菌株共检出82株,其中单产ESBLs 35株(19.55%),单产AmpC酶21株(11.73%),同产ESBLs和AmpC酶26株(14.53%)。产酶株和非产酶株对亚胺培南普遍具有极高敏感性,对其他抗菌药物产酶株耐药率明显高于非产酶株,耐药现象在同产ESBLs和AmpC酶菌株中更为严重。结论本院分离的大肠埃希菌产ESBLs和AmpC酶检出率较高,并且对常用抗菌药物具有较高的耐药率,应引起临床医师高度重视。
Objective To investigate the clinical situation and drug resistance of Escherichia coli producing ESBLs and AmpC enzymes, so as to provide experimental evidence for rational use of antibiotics in clinic. Methods Bacteria was identified by Phoemix 100 microbiological analyzer of BD company in America. K-B method was performed to detect the drug resistances profiles of these strains. And ESBLs were detected by CLSI recommended method. AmpC enzyme was screened by cefoxitin disk diffusion method and confirmatory test was used three dimensional test. Results A total of 82 strains were detected in 179 strains of E.coli producing ESBLs and AmpC enzymes. 35 of them were ESBLs(19.55%), 21 of them were AmpC(11.73%), and 26 of them were ESBLs and AmpC(14.53%). Enzyme producing strains and non producing strains were generally highly sensitive to imipenem. The drug resistance rate of other antibiotics producing strains was significantly higher than that of non producing strains. The drug resistance was more serious in the same strains producing ESBLs and AmpC enzymes. Conclu￣sion The detection rate of ESBLs and AmpC in Escherichia coli isolated from our hospital is higher. And it has high resistance to commonly used antibiotics, which should be attached great attention to.
Objective To investigate the clinical situation and drug resistance of Escherichia coli producing ESBLs and AmpC enzymes, so as to provide experimental evidence for rational use of antibiotics in clinic. Methods Bacteria was identified by Phoemix 100 microbiological analyzer of BD company in America. K-B method was performed to detect the drug resistances profiles of these strains. And ESBLs were detected by CLSI recommended method. AmpC enzyme was screened by cefoxitin disk diffusion method and confirmatory test was used three dimensional test. Results A total of 82 strains were detected in 179 strains of E.coli producing ESBLs and AmpC enzymes. 35 of them were ESBLs(19.55%), 21 of them were AmpC(11.73%), and 26 of them were ESBLs and AmpC(14.53%). Enzyme producing strains and non producing strains were generally highly sensitive to imipenem. The drug resistance rate of other antibiotics producing strains was significantly higher than that of non producing strains. The drug resistance was more serious in the same strains producing ESBLs and AmpC enzymes. Conclu￣sion The detection rate of ESBLs and AmpC in Escherichia coli isolated from our hospital is higher. And it has high resistance to commonly used antibiotics, which should be attached great attention to.
引文
[1] 钱海英. 肺炎克雷伯菌产ESBLs和AmpC酶的检测及耐药性分析[J]. 中华全科医学, 2014, 12(2): 274-275.
[2] 范树养, 刘丰. 胆道感染大肠埃希菌AmpC酶和超广谱β内酰胺酶的检测及耐药分析[J]. 实用医学杂志, 2008, 24(12): 2164-2165.
[3] 尚红, 王毓三, 申子瑜, 等. 全国临床检验操作规程[M]. 3版. 南京: 东南大学出版社, 2015: 568-684.
[4] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twentieth informational supplement[S]. Wayne Pa: Clinical and Laboratory Standards In stitute, 2010.
[5] Pfaller MA, Chaturvedi V, Diekema DJ, et al. Comparison of the sensititre yeast one colorimetric antifungal panel with CLSI microditution for antifungal susceptibility testing of the echinocandins against Candida spp. Using new clinical breakpoints and epidemiological cutoff values[J]. Diagnost Microbio Infect Dis, 2012, 73(4): 365-368.
[6] 周炜, 邵雪华, 彭敏飞, 等. 慢性阻塞性肺疾病急性加重期下呼吸道产超广谱β-内酰胺酶肠杆菌科细菌感染的耐药性分析[J]. 中国医师杂志, 2016, 18(7): 1041-1044.
[7] 林海波, 张国成, 许东亮, 等. 儿童呼吸道感染产超广谱β-内酰胺酶细菌的耐药表型及耐药基因研究[J]. 临床儿科杂志, 2013, 31(2): 129-133.
[8] 丁琳, 凌丽燕, 段达荣. 2010-2012年院内产超广谱β-内酰胺酶肺炎克雷伯菌的感染状况及耐药分析[J]. 中国医药导报, 2014, 11(5): 28-30.
[9] 黄勇, 周珍文, 邓秋连, 等. 儿童感染肺炎克雷伯菌产AmpC酶和ESBLs的检测及耐药性分析[J].热带医学杂志, 2009, 9(4): 406-408.
[10] 龚光明, 李桃, 张晓芳, 等. 产超广谱β-内酰胺酶肠杆菌科细菌的临床分布与耐药性分析[J]. 中华医院感染学杂志, 2016, 26(1): 13-15.
[11] 金海萍, 宋春仙, 余素飞. 产妇医院感染铜绿假单胞菌产AmpC酶耐药基因分析[J]. 中国卫生检验杂志, 2017, 27(11): 1646-1648.
[12] 卢海跃, 林平. COPD患者下呼吸道感染产AmpC酶革兰阴性杆菌耐药基因型研究[J]. 中国卫生检验杂志, 2015, 25(9): 1461-1466.
[13] 许娟, 边保华, 方文雄. 产头孢菌素酶肺炎克雷伯菌耐药表型与基因型分析[J]. 中国预防医学杂志, 2017, 18(9): 685-687.
[14] 赵永新, 李素敏, 张卫群, 等. 产生ESBLs和AmpC酶的肠杆菌细菌检测及耐药性分析[J]. 中国抗生素杂志, 2012, 37(3): 240-243.
[15] 张传领, 葛玉梅, 沈丽芳, 等. 同时产ESBLs和AmpC酶志贺菌临床菌株的分离及鉴定[J]. 中国微生物学和免疫学杂志, 2014, 34(4): 251-255.
[2] 范树养, 刘丰. 胆道感染大肠埃希菌AmpC酶和超广谱β内酰胺酶的检测及耐药分析[J]. 实用医学杂志, 2008, 24(12): 2164-2165.
[3] 尚红, 王毓三, 申子瑜, 等. 全国临床检验操作规程[M]. 3版. 南京: 东南大学出版社, 2015: 568-684.
[4] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twentieth informational supplement[S]. Wayne Pa: Clinical and Laboratory Standards In stitute, 2010.
[5] Pfaller MA, Chaturvedi V, Diekema DJ, et al. Comparison of the sensititre yeast one colorimetric antifungal panel with CLSI microditution for antifungal susceptibility testing of the echinocandins against Candida spp. Using new clinical breakpoints and epidemiological cutoff values[J]. Diagnost Microbio Infect Dis, 2012, 73(4): 365-368.
[6] 周炜, 邵雪华, 彭敏飞, 等. 慢性阻塞性肺疾病急性加重期下呼吸道产超广谱β-内酰胺酶肠杆菌科细菌感染的耐药性分析[J]. 中国医师杂志, 2016, 18(7): 1041-1044.
[7] 林海波, 张国成, 许东亮, 等. 儿童呼吸道感染产超广谱β-内酰胺酶细菌的耐药表型及耐药基因研究[J]. 临床儿科杂志, 2013, 31(2): 129-133.
[8] 丁琳, 凌丽燕, 段达荣. 2010-2012年院内产超广谱β-内酰胺酶肺炎克雷伯菌的感染状况及耐药分析[J]. 中国医药导报, 2014, 11(5): 28-30.
[9] 黄勇, 周珍文, 邓秋连, 等. 儿童感染肺炎克雷伯菌产AmpC酶和ESBLs的检测及耐药性分析[J].热带医学杂志, 2009, 9(4): 406-408.
[10] 龚光明, 李桃, 张晓芳, 等. 产超广谱β-内酰胺酶肠杆菌科细菌的临床分布与耐药性分析[J]. 中华医院感染学杂志, 2016, 26(1): 13-15.
[11] 金海萍, 宋春仙, 余素飞. 产妇医院感染铜绿假单胞菌产AmpC酶耐药基因分析[J]. 中国卫生检验杂志, 2017, 27(11): 1646-1648.
[12] 卢海跃, 林平. COPD患者下呼吸道感染产AmpC酶革兰阴性杆菌耐药基因型研究[J]. 中国卫生检验杂志, 2015, 25(9): 1461-1466.
[13] 许娟, 边保华, 方文雄. 产头孢菌素酶肺炎克雷伯菌耐药表型与基因型分析[J]. 中国预防医学杂志, 2017, 18(9): 685-687.
[14] 赵永新, 李素敏, 张卫群, 等. 产生ESBLs和AmpC酶的肠杆菌细菌检测及耐药性分析[J]. 中国抗生素杂志, 2012, 37(3): 240-243.
[15] 张传领, 葛玉梅, 沈丽芳, 等. 同时产ESBLs和AmpC酶志贺菌临床菌株的分离及鉴定[J]. 中国微生物学和免疫学杂志, 2014, 34(4): 251-255.