产超广谱β-内酰胺酶细菌的检测及感染，耐药特性

Produing extended-spectrum β-lactamases strains:detection infection and resistance

关键词:  ESBLs  drug resistance  gram-negative bacteria

摘要:

了解医院内产超广谱β-内酰胺酶(ESBLs)细菌的种类、分布、耐药特性及产生原因。方法，以头孢噻肟、头孢三嗪、头孢他啶和氨曲南作指示底物，用双纸片协同试验检测ESBLs。结果：716株G-阴性菌检出12种产ESBLs114株，主要由使用过三代头孢史的患者检出。以阴沟肠杆菌、肺炎克类伯菌和大肠埃希菌为主，检出率分别为34.66%(26/75)、19.37%(25/129)和14.75%(36/244)。氨曲南和头孢噻肟是检测ESBLs的最佳指示物。产ESBLs菌对头孢菌素、氨曲南的耐药性高于非产酶株，所有产ESBLs菌对泰能敏感(嗜麦芽窄食单胞菌除外)。结论：产ESBLs菌以阴沟肠杆菌、肺炎克雷伯菌和大肠埃希菌为主，产生与使用三代头孢有关，并可通过质粒在细菌中相互传播。应根据药敏报告选择对ESBLs敏感的药物

Abstract:

To investigate the kinds,distribution and antibiotic resistance of producing extended-spectrum β-lactamases(ESBLs)bacteria in hospital. Methods: The producing ESBLs bacteria were betected by double-disk synergy test with indicators of Aztreonam, Cefotaxime, Ceftriaxone and Ceftazidime. Results:Among 716 gram-negative bacterial isolates producing 114 ESBLs bacteria in 12 kinds were detected.most producing ESBLs bacteria came from the patients treated with the third generation cephalosporins The bcacteria detected were mainly Enterobacter cloacae(E.cl), Klebsiella pneumoniae(K.pn)and Escherichia coli (E.coli). Their prevalence of ESBLs in isolates of [BF]E.Colacae.K.pn and E.coli,were 34.66%(26/75)，19.37%(25/129) and 14.75%(36/244) respectively. The best indicators were Aztreonarn and Cefotaxime. The resistance for cephalosporins and Aztreonarn in producing ESBLs strains was signifycant higher than that of no producing ESBLs. Besides Xanthomonas maltophilia, all producing ESBLs strains were susceptible to Imopenem. Conclusion: Producing ESBLs strains were mainly E.cloacae, K.pneumoniae and E.coli.Their production was related with using the third generation cephalosporins. The resistant plasmid can transmit between bacteria each other. The antibiotic susceptible to producing ESBLs strains could be chosen in treating ESBLs infection.