摘要
目的了解呼吸重症监护室（RICU）分离的常见革兰阴性（G^-）耐药菌产AmpC酶和超广谱β-内酰胺酶（ESBLs）情况及其耐药谱特征。方法采用酶提取物三维试验检测单产AmpC酶、同时产AmpC酶和ESBLs菌株，以美国临床实验室标准化委员会（NCCLS）表型筛选和确认试验检测单产ESBLs菌株，纸片扩散法及E-test进行药物敏感性检测。结果检出单产AmpC酶、单产ESBLs、同时产AmpC酶和ESBLs的细菌分别为28株（16．67％）、71株（42．26％）和12株（7．14％）。AmpC酶检出率在阴沟肠杆菌中最高，为57．14％；ESBLs检出率以肺炎克雷伯菌最高，其次为大肠埃希菌，分别为71．70％和55．81％。单产AmpC酶菌株对亚胺培南和头孢吡肟具有较高的敏感性，耐药率分别为3．57％和28．57％；单产ESBLs菌株对亚胺培南、哌拉西林／他唑巴坦及头孢哌酮／舒巴坦的敏感性较高，耐药率分别为2．82％、32．39％和25．35％；同时产AmpC酶和ESBLs的菌株仅对亚胺培南敏感，未发现耐药株。结论RICU常见G^-耐药菌的AmpC酶和ESBLs检出率较高，该类菌对大多数新型广谱β-内酰胺类抗生素耐药，对亚胺培南敏感。
Objective To investigate antimicrobial resistance and the prevalence of AmpC β-lactamases and extended-spectrum β-lactamases（ESBLs）-producing gram-negative bacteria from specimens of a respiratory intensive care unit（RICU）. Methods AmpC β-lactamases-producing and AmpC β-lactamases combined with ESBLs-producing strains were detected by three-dimensional test, ESBLs-producing isolates were identified with the method recommended by the National Committee for Clinical Laboratory Standard （NCCLS）. Antimicrobial susceptibility of AmpC β-lactamases and ESBLs-producing strains were detected by Kirby-Bauer and E-test methods. Results AmpC β-lactamases, ESBLs and AmpC β-lactamases combined with ESBLs-producing strains were found in 28（16. 67%）, 71 （42. 26%）and 12（7. 14%） strains respectively. The most common AmpC β-lactamases-producing strains was Enterobacter cloacae （57. 14%）; Among ESBLs-producing strains, the most common isolates were Klebsiella pneumoniae （71.70%）and Escherichia coli （55.81%）. The AmpC β-lactamases-producing strains were more susceptible to imipenem and cefepime, the resistant rate of which was 3. 57% and 28. 57% respectively. The resistant rate of ESBLs-producing strains to imipenem, piperacillin/tazobactam and cefoperazone/sulbactam was 2. 82%, 32. 39% and 25. 35% respectively. AmpC β-lactamases combined with ESBLs-producing strains were only sensitive to imipenem, imipenem-resistant strain was not found. Conclusion AmpC β-lactamases and ESBLs-producing gram-negative strains are common in clinical isolates from RICU, and resistance to the majority of new broad-spectrum β-lactamas, but sensitive to imipenem.
出处
《中国感染控制杂志》
CAS
2009年第4期271-273,276,共4页
Chinese Journal of Infection Control
基金
广东省自然科学基金(5009113)
关键词
重症监护室
呼吸系统
医院感染
AMPC酶
ESBLS
抗药性
微生物
抗菌药物
intensive care unit
respiratory system
nosocomial infection
AmpC β-lactamases
extended-spectrum β-1actamases
drug resistance, microbial
antimicrobial agents
