李方+井淼+孙春涛

doi：10.3969/j.issn.1007-614x.2014.21.5

摘 要 目的：探讨婴幼儿感染产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的分布特点及药敏情况，指导临床合理选用抗菌药物治疗。方法：2011年12月-2013年12月送检的痰、血液、脑脊液等标本进行一般细菌培养，血液注入小儿中和抗生素血培养瓶，放置BacT/ALERT3D血培养仪培养，用法国生物梅里埃系统鉴定细菌，以K-B法进行药敏分析。结果：共检出大肠埃希菌120株，其中有49株产ESBLs（40.83%），其中2012年检出大肠埃希菌52株，有13株产ESBLs（25.0%）；2013年检出大肠埃希菌68株，有36株产ESBLs（52.94%）。118株分离自呼吸道标本（98.33%），2株分离自血液（1.67%）。49株产ESBLs大肠埃希菌对青霉素类、头孢菌素类100%耐药，对氨苄西林/舒巴坦和替卡西林/克拉维酸的不敏感率分别为73.6%和42.3%；对哌拉西林/他唑巴坦20.6%中度敏感，79.4%敏感，对头孢哌酮/舒巴坦高度敏感，敏感率86.32%。未出现耐亚胺培南或美洛培南菌株。结论：新生儿感染大肠埃希菌以呼吸道标本检出最多，ESBLs阳性率2013年比2012年有明显升高趋势，对β-内酰胺类抗菌药物耐药严重，多重耐药现象不容乐观，临床应根据药敏试验结果合理选用抗菌药物，避免诱导型耐药菌株的产生。

关键词 超广谱β-内酰胺酶 婴幼儿 大肠埃希菌 感染

Drug sensitivity analysis of production of extended spectrum beta lactamase in escherichia coli in 120 cases

Li Fang，Jing Miao，Sun Chuntao

Clinical Laboratory，the Maternal and Child Health Hospital of the Ningxia Hui Autonomous Region（Yinchuan City，Ningxia） 750004

Abstract Objective：To investigate the distribution and drug resistance situation of production of extended spectrum beta lactamase（ESBLs） in escherichia coli infection in infants and young children，to guide the clinical rational use of antimicrobial drugs.Methods：Sputum，blood，cerebrospinal fluid and other specimens from December 2011 to December 2013 underwent general bacterial culture，blood was injected in antibiotics and blood culture bottle.The blood was placed in the BacT/ALERT3D blood culture for culture.Bacteria were identified by the French bioMerieux system.We conducted sensitivity analysis using K-B method.Results：There were 120 strains of escherichia coli，including 49 ESBLs producing strains（40.83%）.In 2012，there were 52 strains of escherichia coli，including 13 ESBLs producing strains（25%）.In 2013，there were 68 strains of escherichia coli，including 36 ESBLs producing strains（52.94%）.118 strains were isolated from respiratory tract（98.33%），and 2 strains were isolates from blood （1.67%）.49 ESBLs producing strains of escherichia coli were 100% resistant to penicillins，cephalosporins，and not sensitive rate for ampicillin/subatan and ticarcillin/clavulanic acid was respectively 73.6% and 42.3%.It was the moderately sensitive of 20.6% to piperacillin/tazobactam，and sensitivity was 79.4%.It was highly sensitive to Cefoperazone/sulbactam，sensitive rate was 86.32%.There was no resistance to imipenem or meropenem strains.Conclusion：Detection in respiratory specimens is the most.Compared with 2012，the positive rate of ESBLs is significantly increased in 2013.It has a serious resistance to beta lactam antibiotics.The phenomenon of multiple drug resistance is not optimistic.In clinic，we should select antibiotics reasonably according to the results of drug sensitive test in order to avoid induced resistant strains.

Key words Extended spectrum beta lactamases；Nurseling；Escherichia coli；Infection

大肠埃希菌（ECO）是存在于自然界最广泛的条件致病菌，该菌对β-内酰胺类抗菌药物耐药的主要机制是产超广谱β-内酰胺酶（ESBLs），该酶通过水解头孢菌素类、青霉素类、单环类抗生素的β-内酰胺环而对这些药物产生耐药。近年来，对大肠埃希菌耐药性的研究发现，该菌在新生儿感染中耐药性发展较快，以对头孢菌素类抗菌药物耐药性上升最为显著，且呈多重耐药趋势[1]。……