不同来源标本中大肠埃希菌耐药率的比较分析

目的研究不同标本来源中大肠埃希菌的耐药谱,为临床用药提供治疗参考。方法对温州医学院附属第二医院2010年1月到12月患者送检的体液标本进行培养,用microcsan walkaway 96S微生物自动鉴定仪对菌种鉴定及药敏分析,结果用2分割法进行统计分析。结果分离出大肠埃希菌597株,其中痰液、脓液、血液、分泌物、引流液中分别分离出295、148、102、37、15株。所有分离株均对亚胺培南敏感,对氨苄西林、哌拉西林的耐药率最高。痰液分离株对氨曲南、氨苄西林、氨苄西林/舒巴坦、哌拉西林、妥布霉素及所有头孢类的耐药率显著高于血液分离株的耐药率(P<0.05);痰液分离株对氨曲南、氨苄西林/舒巴坦、除头孢他啶外的所有头孢类的耐药率显著高于脓液分离株的耐药率(P<0.05);脓液分离株对氨苄西林、哌拉西林、妥布霉素的耐药率明显高于血液分离株的耐药率(P<0.05)。痰液中ESBLs阳性率显著高于血液和脓液中ESBLs阳性率。产ESBLs的大肠埃希菌共316株,所占的比例为52.9%;痰液分离的ESBLs阳性株对四环素、环丙沙星、加替沙星、左氧氟沙星、甲氧苄啶/磺胺呷恶唑、阿米卡星的耐药率显著低于脓液分离株的耐药率(P<0.05)。结论痰液分离的大肠埃希菌对β-内酰胺类抗生素的耐药率普遍高于脓液和血液分离株的耐药率,同时认识到该院抗生素的耐药现象很严重,临床上更加合理的使用抗菌药物。

Antimicrobial-resistant profile of Escherichia coli from different origins

Objective To investigate the anfimierohial-resistanee of Escherichia coli isolates from different origins, and provide the evidence for clinical therapy. Method All samples from January to December 2010 were cultured; the strains isolated were identified and drug sensitivity tests were done by microsean walkaway 96S microbial identification system; 2 test was performed to identify the significance of difference. Result A total of 597 Escherichia coli strains were iso-lated from sputum （295）, abscess （148）, blood （102）, secretion （37） and aspirate （15）, respectively. All isolates of Escherichia coli were sensitive to imipenem and highest resistant to ampieillin and piperaeiUin. The resistant rates of Esche-richia coll isolates from sputum to aztreonam, ampicillin, ampicillin/sulbactam, piperacillin, tobramyein and all eephalo-sperins were significantly higher than those of isolates from blood （ P 〈 0.05） ; The resistant rates of Escherichia coli isolates from sputum to aztreonam, ampicillin/sulbactam and all cephalosporins except eeftazidime were significantly higher than those of isolates from abscess （P 〈 0.05） ; The resistant rates of Escheriehia coli isolates from abscess to ampieillin, pip- eracillin and tobramycin were significantly higher than those of isolates from blood （ P 〈 0.05 ）. The rates of extended-spectrum β-laetamase （ESBLs） producing Escherichia coli from sputum were significantly higher than those of isolates from blood and abscess. The ESBLs producing Escherichia coil were 316 strains, accounted for 52. 9%. The resistant rates of ESBLs producing Escherichia coli from sputum to tetracycin, ciprofloxacin, gatifloxaein, levofloxacin, trimethoprim/sulfamethoxazole and amikaein were significantly lower than those of isolates from abscess （P 〈 0.05）. Conclusion The resistant rates of Eschericb2a coli from sputum to β-lactam antibiotics are in general significantly higher than those of isolates from abscess and blood, while drug resistance is very serious in our hospital. We should use antimicrobial drugs more rationally in clinical practice.