摘要
目的分析某院大肠埃希菌的临床分布特点及对常用抗菌药物的耐药趋势,为临床预防和控制大肠埃希菌感染提供理论依据。方法采用法国生物梅里埃公司ATB Expression微生物分析仪进行细菌鉴定,采用纸片扩散法(K-B法)进行药物敏感试验,对2013至2015年扬州大学临床医学院临床分离的2 743株大肠埃希菌药物敏感试验进行分析,分别比较感染部位、产ESBLs大肠埃希菌的分离率、产与非产ESBLs大肠埃希菌的耐药率以及对19种抗菌药物的耐药趋势。结果标本分布尿液占56.4%;血液占17.0%。20个科室中肾脏内科最多(占13.5%)、其次为泌尿外科(占8.9%)。患者年龄<65岁者占54.68%,≥65岁者占45.32%。男性占40.90%,女性占59.10%。社区感染者占69.30%,医院感染者占13.20%。泌尿道感染最高(45.90%),其次为菌血症(占14.47%)。产ESBLs大肠埃希菌的分离率为52.6%,耐药率>75%的抗菌药物有头孢唑啉和氨苄西林。非产ESBLs大肠埃希菌对替加环素、亚胺培南、头孢替坦等耐药率高于产ESBLs大肠埃希菌;对复方新诺明、左旋氧氟沙星等抗菌药物的耐药率差异均具有统计学意义(P均<0.05)。大肠埃希菌对氨苄西林/舒巴坦耐药率最高为73.86%,对替加环素耐药率最低为0.11%。对亚胺培南耐药率呈上升趋势,对头孢吡肟、头孢他啶、氨苄西林/舒巴坦等耐药率未见显著上升趋势。结论规范微生物标本的采集,可使大肠埃希菌的标本分布及感染部位发生变化,主要是泌尿道及血流感染。大肠埃希菌的检出率和耐药率逐年上升。肾脏内科、泌尿外科等可经验性选择哌拉西林/他唑巴坦、头孢西丁等。临床工作中应尽可能减少氟喹诺酮类抗菌药物的使用,高度重视亚胺培南等碳青霉烯类药物的合理使用。
Objective To investigate the clinical distribution characteristics and drug-resistance trend to commonly used antibiotics, and to provide evidence for clinical prevention and control of E. coil infection. Methods Total of 2 743 strains ofE. coli isolated from clinical specimens during 2013-2015 in Clinical Medical College of Yangzhou University were performed with drug-sensitivity test, the bacteria identification results were analyzed by the French bio-Merieux ATB Expression automatic bacterial identification instrument and the drug-sensitivity test was conducted with diffusion method （K-B）, then the infection sites, the detection rates of ESBLs-producing E. coli, the resistance rates of ESBLs-producing and non-ESBLs-producing E. coli were analyzed; the drug-resistance trend of 19 kinds of antibiotics were compared, respectively. Results The specimens were isolated from urine （56.4%） and blood specimens （17.0%）. Among the 20 departments from which the specimens were isolated, the proportion of nephrology department of internal medicine was the most （accounting for 13.5%）, and secondly was the urology surgery （8.9%）. The patients under 65 yesrs old accounted for 54.68%, and those above 65 years old accounted for 45.32%; among whom 40.90% were male and 59,10% were female. The community acquired infection accounted for 69.30%, while hospital-acquired infections was 13.20%. Urinary tract infection accounted for the highest proportion （45.9%）, secondly was bacteremia （14.47%）. The detection rates of ESBLs-producing E. coli was 52.6%, the resistance rates of ESBLs-producing E. coli to cefazolin and ampicillin were both above 75%. The resistance rates of non- ESBLs-producing E. coli to tigecycline, imipenem and cefotetan were higher than those of ESBLs-producing E. coli; The antibiotic resistance rates to compound sulfamethoxazole and levofloxacin were significantly different （all P 〈 0.05）. The resistance level of E. coli to ampicillin-sulbactam was 73.86%, which was 0.11% to tigecycline. Although the resistance to imipenem was rising, while the resistance to cefepime, ceftazidime and ampicillin-sullbactam were without significant rising trend. Conclusions Through the standard microbiological specimens collection, specimens distribution and infection sites of E. coli changed, which were mainly urinary tract and bloodstream infection. The detection rate of E. coli and drug resistance rate increased year by year. Application of piperacillin/tazobactam, cefoxitin to kidney and urology could be used empirically, and the use of fluoroquinolone antimicrobial drugs should be reduced. Great importance to the rational use of carbapenem drugs such as imipenem should be attached.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2017年第3期232-238,共7页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
中国医院协会医院感染预防与控制能力建设基金资助项目(No.CHA-2012-XSPX-0629-1)
关键词
大肠埃希菌
超广谱Β-内酰胺酶
耐药性
Escherichia coli
Extended spectrum β-lactamases
Drug resistance
