【摘要】 目的了解宜宾市产超广谱β内酰胺酶(ESBLs)肠杆菌科细菌的耐药情况及耐药基因SHV分布情况。方法采用法国梅里埃Vitek 2 Compact全自动微生物鉴定仪,对2012年1月1日至2015年12月30日该院从临床患者标本中分离出的肠杆菌科细菌进行菌种鉴定及药敏测定,仪器判读为ESBLs阳性的菌株采用纸片法进行表型确定试验,并应用WHONET 5.6软件进行耐药表型分析。随机挑选出210株ESBLs阳性菌株,采用实时荧光定量PCR进行耐药基因SHV检测。结果产ESBLs阳性检出率大肠埃希菌为54.96%(1 318/2 398),肺炎克雷伯菌为33.02%(248/751),产酸克雷伯菌检出率为28.33%(17/60),奇异变形杆菌为14.94%(13/87);耐药基因SHV检出率为48.57%(102/210)。产ESBLs阳性菌株耐药率均较阴性菌株耐药率高,氨苄西林、头孢唑林对产ESBLs菌株的耐药率均在90.00%以上,氨曲南、氨苄西林、舒巴坦、复方新诺明、庆大霉素耐药率均在50.00%以上。头孢替坦、第三代头孢菌素、第四代头孢菌素、亚胺培南、哌拉西林、他唑巴坦耐药性较低。结论宜宾地区产ESBLs肠杆科细菌无论是耐药表型还是耐药基因SHV检出情况与其他地区存在不同程度的差异,这种差异在指导该地区医疗机构经验性使用抗菌药物治疗方面具有重要意义。更多还原

【Abstract】 Objective To investigate the resistant phenotype and the distribution of drug resistance gene(SHV) of ESBLs-producing enterobacteriaceae in Yibin City.Methods The strain identification and drug sensitivity test were carried out on the enterobacteriaceae isolated from the clinical samples collected from January 1st,2012 to December 30 th,2015 by using the automatic bioanalysis French bio Merieux Vitek 2 Compact.Double paper method was used to confirm the ESBLs phenotype.The data of resistance phenotype was analyzed by WHONET5.6 software.Drug resistance gene(SHV)was analyzed by RT-PCR.Results The positive detection rates of ESBLs-producing in Escherichia coli,klebsiella pneumoniae,Klebsiella oxytoca and Proteus mirabilis were 54.96%(1 318/2 398),33.02%(248/751),28.33%(17/60)and 14.94%(13/87),respectively.The detection rate of drug resistance gene SHV was 48.57%.The drug resistance rate of ESBLs positive strains was higher than the negative strains.The resistance rate of ESBLs-producing strains like ampicillin and cefazolin was high up to 90%.As to aztreonam,ampicillin/sulbactam,cotrimoxazole and gentamicin,the resistance rate was above 50%.To cefotetan,ceftazidime,cefepime,imipenem,and piperacillin/tazobactam,the resistance rate was in a relative lower level.Conclusions The resistant phenotype and drug resistance gene(SHV) of ESBLs-producing enterobacteriaceae in Yibin City are different from other regions to some degree.At the time of empirical use of antibiotics,doctors should focus on local research report.更多还原