摘要
目的：通过对耐头孢西丁（FOX）的192株肠杆菌科细菌中AmpC β-内酰胺酶（AmpC酶）和ESBLs的表型检测及耐药性分析，揭示其主要耐药机制和耐药特征。方法：运用双纸片氯唑西林增效试验检测AmpC酶，采用双纸片确诊试验检测ESBLs，最后运用MIC法测定这些菌株对13种抗菌药物的耐药性。采用统计学软件Epilnfor2000、WHONE5．4对实验数据进行分析。结果：受枪菌中共检出高产AmpC酶菌87株，检出率为45．3％，产ESBLs菌共检出96株，检出率为50％。药敏结果显示：单产AmpC酶菌对氨曲南、头孢曲松、头孢噻肟、哌拉西林的耐药率（55．6％～100％）明显高于非产酶菌的耐药率（33．3％～44．4％），两者相比有显著性差异（P〈0．05）。高产AmpC酶菌的4重耐药率（78．9％）与8重耐药率（72．3％）均高于非产酶菌（40．9％）和（36．8％），两者相比有显著性差异（P〈0．05）。结论：AmpC酶与ESBEs已成为肠杆菌科细菌耐药的主要原因之一。临床可选用碳青霉烯类抗菌药物如亚胺培南治疗同时产AmpC酶与ESBLs细菌引起的感染，或采用四代头孢如头孢吡肟治疗单产AmpC酶菌造成的感染，也可根据药敏试验结果选用头孢哌酮／舒巴坦、哌拉西林／他唑巴坦或阿米卡星等抗菌药物治疗。本研究结果提示AmpC酶是形成多重耐药菌的重要原因之，临床常规检测AmpC酶十分必要。
Objective：To detect the phenotype of plasmids-intermediated AmpC β-lactamases and ESBLs in 192 cefoxitin-resistant stains of Gram negative bacilli stains and analyze drugs resistance for main mechanism of drug resistance interpretation and medicate reasonably in clinic.Methods：Cloxacillin-potentiated disk diffusion test were use to detect the phenotype of AmpC β-lactamases and two disk confirming test was used to detect the phenotype of ESBLs,and their antibacterial activities in vitro of 13 antibiotics were analyzed by the minimal inhibitory concentration method.Software EpiInfor 2000 was used to analyze data and WHONE5.4 was used to analyze drug resistance.Results：Among 192 isolates strains,87（45.3%） were detected to produce AmpC β-lactamases.96（50%） of them were detected to produce ESBLs with two disk confirming test.Drug susceptibility test results show that resistance rates（55.6%～100%）of single-AmpC-positve strains to aztreonam,ceftriaxone,Cefotaxime and piperacillin were higher than that of enzyme-negative strains（33.3%～44.4%）.There was significant difference between two groups（P〈0.05）.Resistance rates of single-AmpC-positve strains and enzyme-negative strains to amikacin cefepime imipenem cefoperazone/sulbactam and piperacillin/tazobactam were all comparatively lower（0%～44.4%）,There was significant difference between two groups（P〈0.05）.The rates of four multi-drug resistance（78.9%） and eight multi-drug resistance（72.3%） in single-AmpC-positve strains were obviously higher than those（40.9%） and（36.8%） in enzyme-negative strains.There was significant difference between two groups（P〈0.05）.Conclusion：Drug susceptibility test results show that drug-resistance-enzyme such as AmpC and ESBLs have been one of the most important reason of drug resistance.We suggest to chose imipenem for infections treatment caused by AmpC-positive and ESBLs-positive strains,or chose cefepime for single-AmpC-positve strains,and we could also chose cefoperazone/ su
出处
《中国卫生检验杂志》
CAS
2010年第2期361-362,407,共3页
Chinese Journal of Health Laboratory Technology
