大肠埃希菌和肺炎克雷伯菌中esbls酶和ampc酶的检测结果分析

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1、大肠埃希菌和肺炎克雷伯菌中ESBLs酶和AmpC酶的检测结果分析【关键词】抗生素;耐药性;检测　　［摘要］目的：了解对头孢菌素类耐药的大肠埃希菌和肺炎克雷伯菌中ESBLs和AmpC酶的分布及其对抗生素的敏感性。方法:利用双纸片协同试验及纸片法确证试验检测ESBLs，三相试验检测AmpC酶，并用纸片扩散试验和微量稀释法测定细菌对抗生素的敏感性。结果:从头孢噻肟耐药的大肠埃希菌和肺炎克雷伯菌中检出产ESBLs分别为91.4%和96.7%；产AmpC酶分别为17.1％和10.0％；产SSBL分别为8.6%和6.7％。产酶菌株对三代头孢菌素高度耐药，对环丙沙星、庆大霉素及复方新诺明耐药率较高，对亚

2、安培南敏感，产AmpC酶细菌对含酶抑制剂的复合抗生素高度耐药。结论:产生ESBLs和AmpC酶是大肠埃希菌和肺炎克雷伯菌对头孢菌素耐药的重要机制，实验室应对其检测和监测给予足够重视，临床医生也应了解其对抗生素的耐药规律。　　［关键词］抗生素;耐药性;检测　　DetectionofExtendedSpectrumβlactamasesandAmpCβlactamasesfromEscherichiacoliandKlebslellaPneumoniae8　　Abstract:ObjectiveToknowthedistributionandantimicrobialsusceptibilit

3、yofextendedspectrumβLactamaseandAmpCβLactamaseproducingEscherichiacoliandKlebsiellapneumoniaewhichareresistanttocephalosporins，MethodsAmpCβLactamaseandextendedspectrumβLactamasesweredetectedbythreedimensionaltest，doubledisksynergytestanddiskconfirmatorytestrecommendedbyNationalCommitteeforClinical

4、LaboratoryStandards．Diskdiffusiontestwasusedforantimicrobialsusceptibilitytest，theMICvaluesofAmpCβlactamaseproducingstrainswereexaminedbymicrodilutiontest．ResultsFromEscherichiacoliandKlebsiellapneumoniaeresistanttocefotaxime，extendedspectrumβLactamaseproducerswere91.4%and96.7%,AmpCβLactamaseprodu

5、cersaccountedfor17.1%and10.0%,extendedspectrumSSBLproducerswere8.6%and6.7%,respectively,Thesestrainswerehighlyresistanttothethirdgeneralcephalosporins,butsusceptibletoimpenem．Theirresistanceratiotociprofloxacin，gentamicinandtrimethoprim/sulfamethoxazolewerehigherthanthatofnonproducers.AmpCβLactama

6、seproducerspossessedhighresistancetoantibioticscombinedwithinhibitors．ConclusionExtendedspectrumβLactamasesandAmpCβLactamasesarethe8mostimportantresistancemechanismsofEscherichiacoliandKlebsiellapneumoniaetocephalosporins，muchattentionshouldbepaidtotheirdetectionandsurveillance.Theirresistancetoan

7、timicrobialagentsshouldbeknownbyclinicians.　　Keywords:Antibiotics；Resistance；Detection　　大肠埃希菌和肺炎克雷伯菌是引起尿路感染、呼吸道感染、伤口感染甚至全身严重感染的常见病原菌。近年来发现它们对三代头孢菌素抗生素耐药性增加的原因主要是细菌产生了超广谱β内酰胺酶(extendedspectrumβlactamases，ESBLs)和Am