尿路感染产ESBLs大肠埃希菌检出率及耐药性分析

权小玲，杨文娟，谭桂花

（杨凌示范区医院检验科，陕西 咸阳，712100）

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摘要：

目的 分析本院近3年尿路感染产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的检出率和耐药状况，为临床医师合理使用 抗生素提供参考。方法 收集2012年1月至2014年12月本院尿培养分离出的大肠埃希菌共743株，应用VTECK-2 compat全自动细菌鉴定分析仪进行细菌鉴定及药敏试验，ESBLs菌株按CLSI规定的标准采用双纸片确认法。观察2012—2014年我院产ESBLs大肠埃希菌的检出率及对抗菌药物的耐药率。结果 在743株大肠埃希菌中，产ESBLs菌株的检出率为57.7%；2012—2014各年度检出率分别为52.9%、57.4%和60.7%。产ESBLs菌株对头孢呋辛、头孢曲松、氨苄西林/舒巴坦几乎全部耐药，并对头孢他啶、头孢吡肟、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦耐药率分别为50.0%、30.0%、10.0%左右，对环丙沙星和左氧氟沙星、阿米卡星耐药率分别为70.0%以上和20.0%左右，对亚胺培兰和美罗培兰全部敏感。结论 2012—2014年我院尿路感染产ESBLs大肠埃希菌检出率呈上升趋势，产酶菌的耐药情况较为严重，但阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培兰和美罗培兰对其有较高抗菌活性，可作为初始治疗的经验用药。

关键词：尿路感染；大肠埃希菌；超广谱β-内酰胺酶；细菌耐药性

中图分类号：R446.5文献标志码：A文章编号：2096-1413(2017)14-0010-02

Detection rate and drug resistance of ESBLs-producing Escherichia coli in urinary tract infection
QUAN Xiao-ling, YANG Wen-juan, TAN Gui-hua
(Laboratory Medicine, Yangling Demonstration Zone Hospital, Xianyang 712100, China)

ABSTRACT: Objective To analyze the detection rate and drug resistance of extended -spectrum -Lactamases (ESBLs) producing Escherichia coli in urinary tract infection during the last three years in our hospital, so as to provide a reference for reasonable clinical use of antibiotics. Methods From January 2012 to December 2014, 743 strains of Escherichia coli isolated from urine culture were collected. The bacteria identification and drug susceptibility test were performed by VTECK-2 compat automatic bacteria identification system, and the double-disk synergy test was performed to confirm ESBLs-producing strains by Clinical and Laboratory Standards Institute (CLSI). The detection rate of ESBLs Escherichia coli and the resistance rate of antimicrobial agents in our hospital from 2012 to 2014 were observed. Results Among the 743 strains of Escherichia coli, the detection rate of ESBLs was 57.7%. The annual detection rates of 2012—2014 of ESBLs were 52.9%, 57.4%, 60.7% respectively.ESBLs-producing strains had resistance to almost all of cefuroxime, ceftriaxone and ampicillin/sulbactam. The resistance rates to ceftazidime, cefepime, piperacillin/tazobactam and cefoperazone/sulbactam were around 50.0% , 30.0% , 10.0% respectively, to ciprofloxacin and levofloxacin, amikacin were 70.0% above and 20.0% about. They were all sensitive to imipramine and meropenem.Conclusion The detection rate of ESBLs-producing Escherichia coli in urinary tract infection is on the rise in the hospital during last three years. The drug resistance is severe, but amikacin, piperacillin/tazobactam,cefoperazone/sulbactam, imipenem and meropenem remain the relatively high antibacterial activity,whichcanbeusedforempiricalmedicationintheinitialtreatment.

KEYWORDS: urinary tract infection; escherichia coli; extended-spectrum beta lactamase; bacterial drug resistance

 

参考文献：

[1] 张正琼,黄永茂,毕义亮,等.多药耐药大肠埃希菌质粒介导的的复合-内酰胺酶耐药耐药基因的研究[J].中华医院感染学杂志,2015,25(18):4088-4091.

[2] 方莉萍,吴俊琪,应华永.尿路感染产ESBLs大肠埃希菌耐药性及危险因素分析[J].中国卫生检验杂志,2015,25(24):4336-4342.

[3] 凌宇贵,刘滨,刘卫,等.产ESBLs大肠埃希菌动态监测及耐药性分析[J].中华医院感染学杂志,2014,24(17):4174-4176.

[4] 牛素平,陈炜,赵磊,等.危重症患者尿路感染大肠埃希菌的耐药性分析[J].中华医院感染学杂志,2015,25(2):315-317.