老年患者医院感染前五位常见革兰阴性杆菌ESBLs和AmpCβ-内酰胺酶分析

目的了解华东医院老年患者前5位常见革兰阴性杆菌产酶类型，为指导临床合理选用抗菌药物提供依据。方法收集2011年9月-2012年8月分离自老年医院感染患者的前5位常见的耐头孢西丁的革兰阴性杆菌，用改良的三维试验检测并分析革兰阴性杆菌的产酶类型。结果前5位常见的革兰阴性杆菌分别为鲍曼不动杆菌（88株）、铜绿假单胞菌（61株）、阴沟肠杆菌（42株）、产气肠杆菌（21株）和肺炎克雷伯菌（15株），共计227个菌株；AmpCβ-内酰胺酶（简称AmpC酶）阳性率9．25％（21株），ESBLs阳性率14．10％（32株），同时产AmpC酶和ESBLs酶（简称SSBLs）的阳性率12．78％（29株），其他水解酶阳性率28．19％（64株）。结论老年医院感染患者前5位常见细菌的产酶率高，耐药现象严重，应加强耐药性监测和控制。

Analysis of extended-spectrum beta-lactamases and AmpC beta-lactmase productive rate in the top five Gram-negative bacilli from old nosocomial patients in our hospital

Objective To investigate the distribution of extended-spectrum β-1actamases （ESBLs） and AmpCβ-1acta-mases produced by the top five species cefoxitin-resistant Gram-negative bacilli from old nosocomial patients in our hospital, so as to guide the reasonable use of antibiotics. Methods Gram-negative bacilli were isolated from September, 2011 to August 2012 from old nosocomial patients in our hospital. The modified three dimensional test was used to detect AmpC beta-lactamases and extended spectrum beta-lactmases. Result A total of 227 strains of the five top isolates of Gram-negative bacilli were Acinetobacter baumannii （88 strains）; Pseudomon asaeruginosa （61 strains）; Enterobacter cloacae （42 strains）; Enterobacter aerogenes （21 strains）; Klebsiella pneumoniae （15 strains）. The detection rate of AmpC beta-lactamases, ESBLs, SSBLs and other hydrolase were 9.25% , 14.10% , 12.78% and 28.19% respectively. Conclusions The production rate of AmpC beta-lactamases and ESBLs in the top five species cefoxitin-resistant Gram-negative bacilli from old nosocomial patients in our hospital was high, to strengthen the surveillance of antimicrobial resistance and reasonably use of drugs is the important way to reduce the production and control the dissemission of drug resistant strains in our hospital.