呼吸重症监护室常见细菌产AmpC酶和超广谱β内酰胺酶的检测及耐药性研究
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陆坚

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R378

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广东省自然科学基金(5009113)


Study on antimicrobial resistance and detection of AmpC and extendedspectrum βlactamasesproducing strains in a respiratory intensive care unit
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    摘要:

    目的了解呼吸重症监护室(RICU)分离的常见革兰阴性(G-)耐药菌产AmpC酶和超广谱β内酰胺酶(ESBLs)情况及其耐药谱特征。方法采用酶提取物三维试验检测单产AmpC酶、同时产AmpC酶和ESBLs菌株,以美国临床实验室标准化委员会(NCCLS)表型筛选和确认试验检测单产ESBLs菌株,纸片扩散法及Etest进行药物敏感性检测。结果检出单产AmpC酶、单产ESBLs、同时产AmpC酶和ESBLs的细菌分别为28株(16.67%)、71株(42.26%)和12株(7.14%)。AmpC酶检出率在阴沟肠杆菌中最高,为57.14%;ESBLs检出率以肺炎克雷伯菌最高,其次为大肠埃希菌,分别为71.70%和55.81%。单产AmpC酶菌株对亚胺培南和头孢吡肟具有较高的敏感性,耐药率分别为3.57%和28.57%;单产ESBLs菌株对亚胺培南、哌拉西林/他唑巴坦及头孢哌酮/舒巴坦的敏感性较高,耐药率分别为2.82%、32.39%和25.35%;同时产AmpC酶和ESBLs的菌株仅对亚胺培南敏感,未发现耐药株。结论RICU常见G-耐药菌的AmpC酶和ESBLs检出率较高,该类菌对大多数新型广谱β内酰胺类抗生素耐药,对亚胺培南敏感。

    Abstract:

    ObjectiveTo investigate antimicrobial resistance and the prevalence of AmpC βlactamases and extendedspectrum βlactamases(ESBLs)producing gramnegative bacteria from specimens of a respiratory intensive care unit(RICU).MethodsAmpC βlactamasesproducing and AmpC βlactamases combined with ESBLsproducing strains were detected by threedimensional test, ESBLsproducing isolates were identified with the method recommended by the National Committee for Clinical Laboratory Standard(NCCLS). Antimicrobial susceptibility of AmpC βlactamases and ESBLsproducing strains were detected by KirbyBauer and Etest methods. ResultsAmpC βlactamases, ESBLs and AmpC βlactamases combined with ESBLsproducing strains were found in 28(16.67%), 71 (42.26%)and 12(7.14%) strains respectively. The most common AmpC βlactamasesproducing strains was Enterobacter cloacae (57.14%);  Among ESBLsproducing strains, the most common isolates were Klebsiella pneumoniae (71.70%)and Escherichia coli (55.81%). The AmpC βlactamasesproducing strains were more susceptible to imipenem and cefepime, the resistant rate of which was 3.57% and 28.57% respectively. The  resistant rate of ESBLsproducing strains  to imipenem,piperacillin/tazobactam and cefoperazone/sulbactam was  2.82%, 32.39% and 25.35% respectively. AmpC βlactamases combined with ESBLsproducing strains were only sensitive to imipenem, imipenemresistant strain was not found.ConclusionAmpC βlactamases and ESBLsproducing gramnegative strains are common in clinical isolates from RICU, and resistance to the majority of  new broadspectrum βlactamas, but sensitive to imipenem.

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李国保,李沛,陆坚.呼吸重症监护室常见细菌产AmpC酶和超广谱β内酰胺酶的检测及耐药性研究[J]. 中国感染控制杂志,2009,8(4):271-273.
LI Guobao, LI Pei, LU Jian. Study on antimicrobial resistance and detection of AmpC and extendedspectrum βlactamasesproducing strains in a respiratory intensive care unit[J]. Chin J Infect Control, 2009,8(4):271-273.

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  • 收稿日期:2009-03-06
  • 最后修改日期:2009-05-29
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  • 在线发布日期: 2009-07-30
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