肠杆菌科细菌3年耐药性监测

目的了解我院2008年—2010年间临床常见肠杆菌科细菌的耐药情况及研究耐碳青霉烯类大肠埃希菌碳青霉烯酶基因型,为临床合理使用抗菌药物提供依据。方法收集我院2008-2010年间临床分离的常见肠杆菌科细菌,药敏试验使用纸片扩散法,数据分析采用WHONET5.4软件;筛选出对碳青霉烯类耐药的大肠埃希菌进行碳青霉烯酶基因的PCR检测及基因序列分析。结果 3年分离病原株共4916株,肠杆菌科共1980株,其中列前三位的是大肠埃希菌(873/1980),克雷伯菌属(605/1980)及肠杆菌属(268/1980),其次为变形菌属和沙雷菌属。主要来源于痰液、尿液及分泌物、血液、脓液等。重要肠杆菌科细菌对碳青霉烯类耐药率均小于10%,对头孢哌酮/舒巴坦、阿米卡星、哌拉西林/三唑巴坦者<30%,对广谱青霉素类及头孢菌素类者为40.9%～98.7%。变形菌属除对氨苄西林的耐药率>75%外,对其余抗生素的耐药率均低于40%,。3年来产超广谱β-内酰胺酶大肠埃希菌为33.97%及肺炎克雷伯菌57.50%,对大多数抗生素的耐药率显著高于非ELSBs菌株,且呈多重耐药。3年耐碳青霉烯类的大肠埃希菌共23株,其中产碳青霉烯酶者2株,PCR检测基因型阴性。结论本院肠杆菌科细菌大肠埃希菌和肺炎克雷伯菌检出率较高,碳青霉烯类对肠杆菌科细菌的抗菌活性最高,产ESBLs肠杆菌的耐药严重,实验室应加强对产ESBLs细菌的监测与报告。未检测出我院大肠埃希菌碳青霉烯酶基因型。治疗肠杆菌科细菌感染可选择碳青霉烯类,哌拉西林/三唑巴坦,头孢哌酮/舒巴坦,阿米卡星。

Surveillance on antimicrobial resistance in clinical isolates of Enterobacteriaceae during three years

Objective To investigate the antibiotic resistance of clinical isolates of Enterobacteriaceae from the first Affiliated Hospital of Chongqing Medical University during 2008-2010,and to study on the carbapenemase genotypes in Escherichia coli(E.coli) strains resistant to carbapenems so as to guide the rational use of antimicrobial agents.Methods The common clinical isolates of Enterobacteriaceae from our hospital between 2008 to 2010 were collected.Disk diffusion method was used to determine the antimicrobial susceptibility.WHONET 5.4 and SPSS13.0 software were used to analyze the data;PCR was carried out for detecting the carbapenemases genetypes of the E.coli strains resistant to carbapenems.Results 4916 clinical pathogens and 1980 Enterobacteriaceae were isolated during the 3 years,the isolated E.coli strains accounted for 44.1%(873/1980),followed by Klebsiella 30.6%(605/1980),and Enterobacter 13.5%(268/1980) in Enterobacteriaceae.They were mainliy isolated from sputum, urine,secretions,blood and pus,etc.The resistance rate of Enterobacteriaceae spp to carbapenems was the lowest,<10%,and to cefoperazone/sulbactam,amikacin,piperacillin/tazobactam was less than 30%,The resistance rate of Enterobacteriaceae spp was between 40.9 and 98.7%to broad-spectrum penicillin and cephalosporins.More than 75% Proteus spp were resistant to ampicillin and less than 40%Proteus spp were resistant to other antimicrobials tested. ESBLs-producing strains accounted for 57.5%in E.coli and 33.97%in Klebsiella pneumoniae.The resistant rates of most antibiotics against the ESBL positive strains were higher than ESBL negative strains in E.coli and Klebsiella pneumoniae,and ESBLs-producing strains showed multidrug resistance charicteristcs.A total of 23 E.coli strains were resistant to carbapenems,two of which produced carbapenemases,but none of the common carbapenemase genotypes was detected in the strains.Conclusion Carbapenems including imipenem,meropenem and ertapenem still have the highest activity against Enterobacteriacea in our hospital.The resistance situation of ESBLs-producing strains in Enterobacteriaceae was severe.None of carbapenemase genotypes was detected in our hospital.Carbapenems pipercillin/tazobactam,cefoperazone/sulbactam and amikacin can be choosed for treatment of Enterobacteriaceae.