【摘要】 目的了解大肠埃希菌和肺炎克雷伯菌产AmpC酶的情况及耐药性分析,为临床合理用药提供依据。并对17种抗菌药做药敏试验,比较产酶菌与非产酶菌对12种抗菌药的耐药率,为临床治疗产酶菌感染提供理论依据。方法菌株来源于2006年4月-2008年12月东莞市太平人民医院住院患者送检合格标本中分离的大肠埃希菌80株、肺炎克雷伯菌101株。应用头孢西丁三维试验检测AmpC酶,用三维试验抑制试验及AmpC酶诱导试验对表型可疑产AmpC酶的菌株进行检测。以K-B琼脂扩散法做药敏试验,并采用MIC法进行验证。结果在181株大肠埃希菌和肺炎克雷伯菌中,64株(35.4%)产AmpC酶,产酶株对亚胺培南、头孢吡肟耐药率低,另外MIC法显色药敏检测板与K-B法有较高符合率,能提供准确的耐药提示。结论产生AmpC酶是大肠埃希菌和肺炎克雷伯菌对头孢类抗菌药物耐药的又一重要机制,实验室应对其检测与监测给予足够重视,以指导临床合理选用抗菌药物、减缓对细菌耐药的选择性压力、避免医院感染的发生和流行。治疗应以亚胺培南为首选,头孢吡肟可作为选用药物之一,应推广使用MIC法。更多还原

【Abstract】 Objective To investigate the production and resistance of AmpCβ-lactamases in Escherichia coli and Klebslella pneumoniae in Taiping People’s Hospital of Dongguan,and to compare the resistance rate of enzymes-producing strains and non-enzymes producing strains to 17 antibiotics for the basis of treating infection caused by enzymes producing strains. Methods A total of 181 strains were isolated from the patients hospitalized in Taiping People’s Hospital of Dongguan form April,2006 to December,2007,80 strains of them were Escherichia coli and 102 strains of them were Klebsiella pneumoniae.Cefoxitin three-dimensional test and E-test were used to detect AmpC enzyme,three dimensional depression test and AmpC-lactamases inducing test were adopted to detect the phenotype of screening strains producing AmpC-lactamases,and the method of MIC was applied to confirm. Results Sixty-four(35.4%) strains were AmpC positive.Cefepime and amikacin were also effective for the treatment of such infections.Enzyme production strains had low resistance rate to imipenem and cefepime.Another MIC susceptibility testing method consisted with K-B method could provide prompt and accurate drug resistance rate. Conclusions AmpC β-lactamases are the another most important resistance mechanisms of E.coli and K.pneumoniae,much attention should be paid to their detection and surveillance,it will direct the clinics to use antibiotics reasonably,relieve the selective pressure of bacteria resistance,and avoid the nosocomial infection.The first choice for treatment should be imipenem and cefepime,and MIC method should be promoted.更多还原