大肠埃希菌和肺炎克雷伯菌中ESBLs酶和AmpC酶的检测结果分析_临床医学论文.docVIP

大肠埃希菌和肺炎克雷伯菌中ESBLs酶和AmpC酶的检测结果分析_临床医学论文 大肠埃希菌和肺炎克雷伯菌中ESBLs酶和AmpC酶的检测结果分析_临床医学论文 【关键词】 抗生素;耐药性;检测 　　［摘要］ 目的：了解对头孢菌素类耐药的大肠埃希菌和肺炎克雷伯菌中ESBLs和AmpC酶的分布及其对抗生素的敏感性。方法:利用双纸片协同试验及纸片法确证试验检测ESBLs，三相试验检测AmpC酶，并用纸片扩散试验和微量稀释法测定细菌对抗生素的敏感性。结果:从头孢噻肟耐药的大肠埃希菌和肺炎克雷伯菌中检出产ESBLs分别为91.4%和96.7%；产AmpC酶分别为17.1％和10.0％；产SSBL分别为8.6%和6.7％。产酶菌株对三代头孢菌素高度耐药，对环丙沙星、庆大霉素及复方新诺明耐药率较高，对亚安培南敏感，产AmpC酶细菌对含酶抑制剂的复合抗生素高度耐药。结论:产生ESBLs和AmpC酶是大肠埃希菌和肺炎克雷伯菌对头孢菌素耐药的重要机制，实验室应对其检测和监测给予足够重视，临床医生也应了解其对抗生素的耐药规律。 　　［关键词］ 抗生素;耐药性;检测 　　Detection of Extended Spectrum βlactamases and AmpC βlactamases from Escherichia coli and Klebslella Pneumoniae 　　Abstract:Objective To know the distribution and antimicrobial susceptibility of extended spectrum βLactamaseand AmpC βLactamaseproducing Escherichia coli and Klebsiella pneumoniae which are resistant to cephalosporins，Methods AmpC βLactamase and extended spectrum βLactamases were detected by threedimensional test，double disk synergy test and disk confirmatory test recommended by National Committee for Clinical Laboratory Standards． Disk diffusion test was used for antimicrobial susceptibility test， the MIC values of AmpC βlactamaseproducing strains were examined by microdilutiontest．Results From Escherichia coli and Klebsiella pneumoniae resistant to cefotaxime，extended spectrum βLactamaseproducers were 91.4%and 96.7%,AmpC βLactamaseproducers accounted for17.1% and 10.0%,extended spectrum SSBL producers were 8.6% and 6.7%,respectively,These strains were highly resistant to the thirdgeneral cephalosporins,but susceptible to impenem．Their resistance ratio to ciprofloxacin， gentamicin and trime thoprim/sulfamethoxazole were higher than that of nonproducers.AmpC βLactamaseproducers possessed high resistance to antibiotics combined with inhibitors．Conclusion Extended spectrum βLactamases and AmpC βLactamases are the most important resistance mechanisms of Escherichia coli and Klebsiella pneumoniae to cephalosporins，much attention should be paid to their detection and surveillance.Their r