张帅,费樱,焦彦朝
ZHANG Shuai,FEI Ying,JIAO Yanchao

• 1:贵阳医学院医学检验系
• 2:贵阳医学院附院微生物免疫科
• 3:贵州出入境检验检疫局

摘要(Abstract)：

目的:分析2008年1月~2013年9月大肠埃希菌的检出情况及对抗菌药物的耐药性。方法:对送检标本进行细菌鉴定和药敏试验,观察各年大肠埃希菌检出率、耐药性,不同标本来源、不同送检科室检出大肠埃希菌的耐药性,并观察产超广谱β-内酰氨酶(ESBLs)大肠埃希菌检出率。结果:6年共分离大肠埃希菌4 607株,各年大肠埃希菌的检出率为18.2%~26.5%,大肠埃希菌对氨苄西林和哌拉西林的耐药率最高(>91.0%),对亚胺培南的耐药率最低(<3.0%),2010-2013年对环丙沙星、庆大霉素、复方磺胺甲恶唑和妥布霉素抗菌药物的耐药率有所下降(P<0.05);血液标本来源的大肠埃希菌耐药率低于其他标本来源大肠埃希菌的耐药率,来自ICU的大肠埃希菌对常见抗菌药物的耐药率普遍较高,其次为外科,儿科送检标本检出的大肠埃希菌耐药率较低;2010年大肠埃希菌产ESBLs菌株检出率为37%,2012年为70.9%,2010-2012年产ESBLs的大肠埃希菌检出率逐年上升。结论:6年内大肠埃希菌分离株增多,耐药情况严峻,ESBLs产酶率较高,应加强本地区抗菌药物使用合理性。
Objective: To investigate detection rate of Escherichia coli( E. coli) from January 2008 to September 2013 and to analyze its drug resistance. Methods: The samples from different resources and clinical departments were collected to identify bacteria and to test their drug sensitivity. The detection rate of E. coli and drug resistance were analyzed. Especially,the detection rate of E. coli producing extended spectrum β lactamases( ESBLs) was observed. Results: During the six years from 2008 to 2013,4 607 strains of E. coli were separated. The overall detection rates were 18. 2% ~ 26. 5%.Drug resistance rates of E. coli to ampicillin,piperacillin were the highest( > 91. 0%),while it to imipenem was the lowest( < 3. 0%). During the period of 2010- 2013,drug tolerance rates of E. coli to ciprofloxacin,gentamycin,compound sulfamethoxazole and tobramycin decreased( P < 0. 05).The drug resistance rate of E. coli from blood samples was lower than that from other sources. The drug resistance rate of ICU-sourced E. coli to common antibiotics was generally in higher level,followed by those from departments of surgery and pediatrics; The detection rate of E. coli producing ESBLs was 37%in 2010 and 70. 9% in 2012 showing a rising tendency. Conclusions: The isolate amount of E. coli keeps on creasing during the 6 years,the situation of drug resistance is severe,and the producing rate of ESBLs is relatively high. It is suggested to strengthen the administration rationality of antibiotics.

关键词(KeyWords)： 大肠埃希菌;药物耐受,细菌;抗菌药;超广谱β-内酰氨酶
E.coli;drug tolerance;bacteria;antibiotics;extended spectrum β lactamases

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张帅,费樱,焦彦朝
ZHANG Shuai,FEI Ying,JIAO Yanchao

DOI: 10.19367/j.cnki.1000-2707.2015.01.013

参考文献(References)：

• [1]马越,李景云,张新妹,等.1999-2002年北京、广东、湖北和辽宁地区大肠埃希菌及肺炎克雷伯氏菌临床分离株耐药性比较分析[J].中国抗生素杂志,2004(4):226-234.
• [2]刘坤友.耐药性大肠杆菌研究进展[J].中外健康文摘,2011(31):119-121.
• [3]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:357-360.
• [4]中华医学会.抗菌药物敏感性试验执行标准[J].中华检验医学杂志,2013(1):21-23.
• [5]吴雪梅.242例大肠埃希菌耐药性分析[J].现代诊断与治疗,2013(5):987-988
• [6]汪复,朱德妹,胡付品,等.2008年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2009(5):321-329.
• [7]汪复,朱德妹,胡付品,等.2009年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2010(5):325-334.
• [8]朱德妹,汪复,胡付品,等.2010年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2011(5):321-329.
• [9]胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012(5):321-329.
• [10]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013(5):321-330
• [11]张淑清.产ESBLs大肠埃希菌对氨基糖苷类药物耐药基因研究[J].中国实验诊断学,2012(16):299-301.
• [12]Jacoby GA.Genetics of extended-spectrum beta-lactamases[J].European Journal of Clinical Microbiology and Infectious Diseases,1994(1):2-11.
• [13]席学莉,马文,桂坤,等.产超广谱β-内酰胺酶细菌院内肺部感染情况及耐药性分析[J].贵州医药,2002(7):612-613.
• [14]Domenech-Sanchez A,Pascual A,Suarez AI,et al.Activity of nine antimicrobial agents against clinical isolates of klebsiella paeumoniae producing extended-spectrumβ-lactamases and deficient or not in porins[J].J Antimicrob Chemother,2000(46):858-859
• [15]吴开明.大肠埃希菌的分离及耐药情况分析[J].大家健康,2013(5):42-43.

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