摘要
目的 了解医院阴沟肠杆菌感染的临床分布及耐药性，以指导临床防治该菌感染。方法 采用K—B纸片扩散法检测药物敏感性，通过改良酶提取物头孢西丁和头孢曲松三维试验检测AmpC β-内酰胺酶（AmpC酶）和产超广谱β-内酰胺酶（ESBLs）。结果 2002年1月～2004年12月临床分离阴沟肠杆菌162株，标本来源主要为痰液、尿液、伤口分泌物，分别占62．3％、11．7％、9．9％，73．5％菌株分离自各病区重症监护病病房（ICU）；单产AmpC酶、同时产AmpC酶和ESBLs、单产ESBLs检出率分别为19．1％、11．7％、14．2％；产酶株的耐药性明显高于非产酶株，耐药现象在同时产AmpC酶和ESBLs菌株中尤为严重，全部菌株对亚胺培南敏感。结论 临床上阴沟肠杆菌主要引起呼吸道、尿路和各种伤口感染，并多发于ICU患者；AmpC酶和ESBLs在阴沟肠杆菌中广为流行，限制β-内酰胺类抗菌药物的应用是减少产酶株流行的重要措施。
OBJECTIVE To investigate the clinical distribution and antimicrobial resistance of infections caused by Enterobactercloacae in our hospital, for guiding the prophylaxis and treatment of these infections in clinical practice. METHODS Antimicrobial susceptibility tests were done by Kirby-Bauer disk diffusions method, the phenotypes of E. cloacae strains harboring AmpC β-lactamases and extended-spectrum β- lactamases （ESBLs） were detected by modified three-dimensional extract test. RESULTS A total of 162 strains of E. cloacae were isolated between Jan 2002 and Dec 2004, the percentages of these strains isolated from sputum, urine and wound secretion were 62.3%, 11.7% and 9. 9%, respectively. 73.5% of all strains isolated from intensive care unit （ICU） in every endemic area. AmpC β-1actamases, AmpC β-lactamases combined with ESBLs and ESBLs producing strains were detected in 19.1 %, 11.7% and 14. 2% of E. cloacae, respectively. The resistance of AmpC β-lactamases or ESBLs producer was obviously higher than that of non-AmpC β-lactamases and ESBLs producer, while the phenomenon of resistance was serious especially in AmpC β-lactamases combined with ESBLs producer, but all strains were sensitive to imipenem. CONCLUSIONS E. cloacae causes infections of respiratory tract, urinary tract and wound principally in clinic, the most of which occurred in ICU. AmpC β-lactamases and ESBLs are popular in E. cloacae, the restricted use of β-lactams is a considerable measure which reduces prevalence of AmpC β-lactamases and ESBLs producing strains. The antimicrobial agents for treating infections caused by E. cloacae should be chosen according to the results of the antimicrobial susceptibility tests, imipenem is the first choice for severe infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2006年第10期1174-1177,共4页
Chinese Journal of Nosocomiology
关键词
阴沟肠杆菌
耐药性
抗菌药物
Β-内酰胺酶类
Enterobacter cloacae
Antimicrobial resistance
Antibiotics
β-Lactamases
