产超广谱B-内酰胺酶细菌监测及药敏分析［摘要］目的：探讨产超广谱B-内酰胺酶(ESBLs)菌株的监测与耐药性的临床意义。方法：对临床分离出的G-杆菌,主要是肠杆菌科的细菌在进行药敏试验同时进行ESBLs的检测，采用1999年NCCLS建议的确证试验。药敏试验采用纸片扩散(K_B)法敏感试验(改良K~B法)。结果：486株共检出132株产ESBLs菌，总检出率为27.2%,其中，160株大肠埃希菌检出产ESBLs菌42株，检出率为27.0%；76株肺炎克雷伯菌检出产ESBLs菌28株，检出率为36.8%o2种主要检出产ESBLs菌株的药敏试验结果，大肠埃希菌对9种常用抗生素的敏感率依次为：亚胺培南〉阿米卡星〉阿莫西林/克拉维酸〉头胞哌酮/舒巴坦＞头胞酊〉庆大霉素〉环丙沙星〉妥布霉素〉复方磺胺甲■呢。肺炎克雷伯菌对9种常用抗生素的敏感率依次为:亚胺培南〉头砲哌酮/舒巴坦〉头砲酊＞阿莫西林/克拉维酸〉环丙沙星〉阿米卡星〉复方磺胺甲■哩〉妥布霉素。结论：通过对ESBLs菌株的监测掌握了解地区性细菌耐药趋势，动态观察细菌的变迁规律，将为临床合理选择抗生素、避免细菌耐药和减缓细菌耐药的发生具有重要的临床意义。［关键词］B-内酰胺酶；大肠埃希菌；肺炎克雷伯菌；耐药性分析［中图分类号］R978.11［文献标识码］B［文章编号］1673-7210(2010)04(c)-107-02Examinationandresistanceanalysisofproducingex-tended-spectrumB-lactamasestrainsMEIChaoming(DepartmentofClinicalLaboratory,YunfuPeoplersHospital,Yunfu527300,China)[Abstract]Objective：Toinvestigateclinicalsig-nificanceofexaminationandresistaneeanalysisofpro-ducingextended-spectnimB-lactamasestrains.Methods：Thegramnegativebacilliwereisolatedfromclinicsam-ples,mainlyenterobacteriaceaebacteria,adrugsensitivetestwasperformedbypaperdiffusionmethod(modifiedK-Bmethod)anddetectionofesblswasdoneatthesametimebytheconfirmatorytestwhichrecommendedbyNCCLSin1999foreachofthestrains・Results：132strainsofesbls-producingbacteriaweredetectedfrom486strains,thetotaldetectedratewas27.2%,including42strainsofesbls-producingbacteriawhichweredetectedfrom160strainsofColonBacillus,thedetectionratewas27.0%,and28strainsofesbls-producingbacteriawhichwerede-tectedfrom76strainsofKlebsiellaPneumoniae,thede-tectionratewas36.8%.Thedrugsensitivetestresultsofthetwomainesbls-producingstrainswere：thesensitivityratesofEscherichiaColito9commonlyusedantibioticswas：imipenem>amikacin>amoxicillin/clavulanicacid>cefopera-zone/sulbactam>cephalosporintincture>gentamycin>ciprofloxacin>tobramycin>compoundsulfamethoxazole・ThesensitivityratesofKlebsiellaPneumoniaeto9commonlyusedantibioticswas:imipenem>cefoperazone/sulbactani>cephalosporintincture>amoxicillin/clavulanicacid>ciprofloxacin>amikacin>compoundsulfamethoxazole>to-bramycin.Conclusion：Toinvestigatethelocaltendencyofthedrugresistanceofbacteriaandobservethelawsofbacterialchangedynami-callythrongthemonitoringofesblshasamimportaritclinicalsignificancetotherationaluseofantibioticsinclinic,avoidandslowdownthedrugresistanceofbac-teria・[Keywords]P-lactamase；EscherichiaColi；Kleb-siellaPneumonia；Drugresistanceanalysis近年来细菌耐药性问题不仅在我国十分严重[1],也是全球范围广泛存在且有待解决的棘手问题。随着超广谱B-内酰胺类抗生素在临床广泛应用，细菌产生了质粒介导的超广谱B-内酰胺酶。超广谱B-内酰胺酶是质粒介导的与G-杆菌耐药性有关的酶，它可造成医院感染的流行。本试验的目的是了解ESBLs在本地区流行的情况。由于许多产ESBLs菌株在常规体外药敏试验时，表现出对第三代头胞菌素和胺曲南的低水平耐药甚至敏感，但临床治疗无效。故笔者认为,应将ESBLs的检测作为临床微生物实验室的常规工作。掌握了解地区性细菌耐药趋势，动态观察细菌的变迁规律，及时将信息报告给临床医生，以有效地...