阴沟肠杆菌高产AmpC酶及ESBLs检测及其耐药性探究.docVIP

阴沟肠杆菌高产AmpC酶及ESBLs检测及其耐药性探究 　 作者：耿燕，张王刚，王香玲，杨会斌，张毅，李淑琴 【摘要】 目的：了解本地区阴沟肠杆菌高产AmpC酶和超广谱β内酰胺酶(ESBLs)的流行状况及其耐药性。方法：收集154株临床分离无重复阴沟肠杆菌，通过改良三维实验检测阴沟肠杆菌高产AmpC酶和超广谱β内酰胺酶(ESBLs)，运用K-B琼脂扩散法进行药物敏感性试验。结果：在154株菌中，18.83％的菌株单产ESBLs，22.73％的菌株单产AmpC酶，5.19％的菌株同时产AmpC酶和ESBLs，53.25％的菌株AmpC酶和ESBLs均不产生。产不同类型β内酰胺酶其耐药性有所不同。结论：本地区阴沟肠杆菌产AmpC酶和ESBLs的流行处于一个相对较高的水平。高产AmpC酶菌株对一、二、三代头孢菌素、头孢西丁、酶抑制剂复合制剂等高度耐药，对头孢吡肟敏感，而产ESBLs菌株对三代头孢菌素、头孢吡肟均不同程度耐药，而对各种酶抑制剂复合制剂保持较高的敏感性，因此，产Ampc酶及ESBLs酶的细菌的耐药性不完全相同，产酶类型不同需选用不同类型的抗生素。 【关键词】 阴沟肠杆菌；AmpC酶；ESBLs；改良三维实验；耐药性 　　Study on the Detection of AmpC Enzyme Hyperproduction and　Extendedspectrum βlactamases and its Antimicribial Resistance in Clinical Isolates of Enterobacter Cloacae 　　Abstract:Objective To detect the stably derepressed expression of AmpC βlactamases (AmpC) and extended spectrum βlactamases (ESBLs) of Enterobacter cloacae，and its antimicrobial activities.Methods 154 clinical strains of Enterobacter cloacae were collected from five hospitals in Xi’an area from January 2004 to June 2005；Modified threedimensional of cefoxitin／cefiriaxone test were used to detect AmpC and ESBLs respectively；LirbyBauer (K-B) method were performed to detect the susceptibility of 16 antimicrobial agents against Enterobacter cloacae.Results The incidence rate of single producing AmpC was 22．73％；the incidence rate of single producing ESBLs was 18．83％；the incidence rate of producing both enzymes was 5．19％；the incidence rate of producing neither AmpC nor ESBLs was 53．25％.Conclusion The study demonstrated that the prevalence of strains producing AmpC and／or ESBLs isolated from patients in Xi’an area was at a higher level compared with other cities in our country；the strains producing AmpC and／or producing ESBLs were multipleantibioticsresistant to βlactamases cephalosporins;the best antibiotics for treatment of infections caused by AmpCproducing strains in Enterobacier cloacae is Imipenem，followed by Cefpirome；the best antibiotics for treatment of infections caused by ES