【作者】 林庆安；

【导师】 罗文侗；

【作者基本信息】 第二军医大学 ， 内科学（呼吸系病）， 2000， 硕士

【摘要】 【目的］了解上海地区肠杆菌科细菌产超广谱β-内酞胺酶 （ESBLs）情况；了解产ESBLs菌对11种常见抗生素的耐药情 况；比较并评价双纸片协同扩散法、Etest法和双纸片增效法对 ESBLs的检出率。 [方法] 收集 1999年 3月～1999年 10月上海地区 4家医院 分离的肠杆菌科细菌 1026株，用Kirby-Bauer法作药敏试验；用 双纸片协同扩散法检测ESBLs；分别用双纸片协同扩散法、Etest 法和双纸片增效法三种方法对10株参考产ESBLs菌株与200株 临床肺炎克雷伯杆菌和大肠埃希菌菌株检测ESBLs。 [结果] 常规药敏试验结果显示，在 11种抗生素中耐药率最 低的是亚胺培南（0．10％）和头孢美唑（13．84％） 耐药率最高的 是环丙沙星（47．56％）和头孢呋新（43．96％） 其中环丙沙星对大 肠埃希菌的耐药率高达68．88％；除头孢他啶外，其它第三代头 孢菌素和氨曲南的耐药率均在 30％以上，高于阿米卡星的耐药率 （2．26％）；在所有肠杆菌科细菌中，阴沟肠杆菌的耐药问题尤 为严重，仅亚胺培南和阿米卡星敏感性较好，分别为 100％和 70．91％。在 1026株肠杆菌科细菌中，用双纸片协同扩散法共检 出产ESBLs菌352株，检出率为34．31％，其中肺炎克雷伯杆菌 为37．40％，大肠埃希菌为30．21％,阴沟肠杆菌为41．82％，产气 肠杆菌和枸橼酸杆菌也分别检测到产ESBLs菌；各种来源标本 上躇站互厂方亦杆勿q产走广办p－o 份况和矽仪士肘－ 肠杆茵科细菌产ESBLs率无显著差异，各种杭生素纸片对ESBLs 的检出率也无显著差异；除亚胺培南和头抱美哇外，产ESBLs 菌对其它 9种抗生素的耐药率显著高于非产 ESBLs菌（P＜0．of）， 亚胺培南和头抱美哇对产 ESBLS菌的敏感性最高，分别为 100O 和 84．66o。在 10株参考产 ESBLs菌株中，用双纸片协同扩散法、 Etest法和双纸片增效法三种方法分别检出 9株、9株和 10株， 检出率分别为 90％、90％和 100％。i种方法对 200株临床菌株 中产ESBLs菌的检出率分别为刀％、75％和79％，三种方法间 无显著差异。 l结论］上海地区肠杆菌科细菌中产 ESBLs菌流行情况严 重，上海地区临床实验室有必要常规检测肠杆菌科细菌是否产 田＊L引 上海地区肠杆菌科细菌耐药问题严重，产田＊k菌对大 多数抗生素的耐药性比非产ESBLs菌严重得多，亚胺培南和头 袍美哩是治疗由产ESBLs菌引起感染的有效抗生素；双纸片协 同扩散法和双纸片增效法敏感性高、经济、操作简便易行，适宜 在各级医院临床实验室推广普及。更多还原

【Abstract】 [Objectives] To investigate extended-spectrum beta- lactamases(ESBLs) production in clinical isolates of the family Enterobacteriaceae in Shanghai and the resistant rates of ESBLs- producing strains to antibiotics; To evaluate the isolating rates of ESBLs by double-disk synergy test, Etest and inhibitor-potentiated disk-diffusion test respectively. [Methods] 1026 clinical isolates of the family Enterobacteriaceae were collected from 4 hospitals in Shanghai from March 1999 to October 1999. Kirby-Bauer method was used to judge drug sensitivity; Double-disk synergy test was used to detect ESBLs. Double-disk synergy test, Etest and inhibitor-potentiated disk- diffusion test were used to detect ESBLs in 10 reference strains and 200 clinical isolates of Klebsiella pneumoniae and Escherichia coli respectively. [Resultu] In 11 antibiotics, Imipenem and Cefmetazole had the lowest resistant rates of 0.10% and 13.84% respectively, while Ciprofloxacin and Cefuroxime had the highest resistant rates of 47.56% and 43.96% respectively, and the resistant rate of Escherichia coli strains to Ciprofloxacin was 68.88%; Except Ceflazidime, the resistant rates of oxyimino-lactams and monobactatns were more than 30%, which was higher than that of Amikacin(32.26%). In the boly Enterobacrtceae, the resistance of Enterobacter clOacaewas especially serious, and only the sensforities of boenem andWacin were good, with the sensitive rates being l00% and 70.9l%respectively In all l026 clforcal isolates of the familyEnterobacteriaceae, 352 stheins were considered ESBLs producers bydouble-disk synergy test, with the isolatin rate being 34.3l%.37.40%, 30.2l% and 41.82% of strains of Klebsiella pneumonltre,Eschwtia coll and Enterobacter cloacae resPectlyely wereconsiderd ESBLs producers. ESBLs was also detected in strains ofEnterObacter aerWes and Cbobacter hedi. There was noevident difference in the isolating rates betWeen differen clforcalsPecAnens, so was With difor antibiOtic disks. ExcePt bomand Cefinerezole, the resishat rates of ESBLs-producing strains toother 9 antibiotics were much higher than that of non-ESBLs-produCing strains(P < 0.0l). The resistan rates of twenem andCebole to ESBLs-producing triins were the loweSt. In l0reference strains, 9, 9 and l0 shas were considered ESBLs-producing strains by double-disk Synergy tCst, Etest, inhiitOrpotentiated disk-ditheion test resPectively In 200 clforcal isolates ofKlebsiella pneumoniae and EscheriChia coli, 73%, 75% and 79%were considered ESBLs producers with the three methodsrespechvely which were not differen evidentlyIConclusionsl The PrCvalence of ESBLs in clinical isolates ofthe boly EnterObacrtceae in Shanghai was high, and it isnecessary for clforcal laboratory to deect ESBLs in clforcal isolates ofthe family Enterobacteriaceae in routine. The resistan rates ofESBLs-producing strains to most antibiotics were much higher thantha of non-ESBLs-producing strains. Iwienem and CeAnetazolewere the effective anibiotics tO infections caused by ESBLs-producing stheins. Double-disk synergy test and inhibitorTotentiateddisk-diffosion test are sutable for screening ndins producing ESBLsin rouine in all hospitals.更多还原