大肠埃希菌所致泌尿生殖系感染的细菌耐药分析

南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (08): 940-942,945.

大肠埃希菌所致泌尿生殖系感染的细菌耐药分析

崔伟历, 徐德兴, 李文玲, 王露霞

广州军区广州总医院, 广东, 广州, 510010

出版日期:2004-08-20 发布日期:2004-08-20
基金资助:
收稿日期:2004-2-10。
作者简介:崔伟历(1951-),女,副主任技师,电话:020-36224784

Analysis of anti-microbial resistance of Escherichia coli that caused infection in urogenital system

CUI Wei-li, XU De-xing, LI Wen-ling, WANG Lu-xia

广州军区广州总医院, 广东, 广州, 510010

Online:2004-08-20 Published:2004-08-20

摘要/Abstract

摘要： 目的对导致泌尿生殖系感染的大肠埃希菌对抗菌素的耐药趋势进行调查分析。方法应用纸片扩散法(K-B法)对分离的148株大肠埃希菌进行药敏测试与分析,并用纸片扩散法对β-内酰胺酶(ESBLs)菌株作确认试验。结果对28种抗生素的耐药检测结果显示,大肠埃希菌对青霉素类和喹诺酮类抗生素耐药率达73.6%~86.4%;对一代、二代头孢菌素(头孢拉啶、头孢唑啉、头孢克洛)耐药率在44%以上;对三代头孢菌中的头孢他啶耐药率最低,为10.1%;对哌拉西林、头孢哌酮和氨苄西林的耐药率为84.5%、44.6%、83.0%;对含酶抑制剂的复合β-内酰胺类抗生素的耐药率(哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和氨苄西林/舒巴坦为4.1%、10.8%和52.0%)要明显低于单剂型的同种抗生素,抗菌敏感率均有不同程度的提高(P<0.001)。148株大肠埃希菌中,产ESBLs菌株有38株(25.7%),不产ESBLs菌株有110株(74.3%)。产ESBLs菌株对多种抗生素的耐药率显著高于不产ESBLs的菌株(P<0.05)。结论对于治疗因大肠埃希菌引起的泌尿生殖系感染,应该根据实验室的药敏和ESBLs的检测结果来指导合理用药,以提高治疗效果。呋南妥因和含酶抑制剂的β-内酰胺类抗生素比较有效。

Abstract: Objective To study the anti-microbial resistance of Escherichia coli (E.coli) that caused infection in urogenital system. Method Anti-microbial susceptibility tests for 148 strains of E.coli were conducted by disc diffusion technique. Results In 28 commonly used antibiotics, the resistance rates of E.coli to β-lactam and quinolones were high (73.6%-86.4%). High resistance rates to the first- and the second-generation cephalosporin (cefradime, cephazolin and cefaclor) were also observed (44%). Resistance rate to ceftazidime is the lowest (10.1%) in the third-generation cephalosporin. The resistance rates of E.coli to piperacillin, pefoperazone and ampicillin were 84.5%, 44.6% and 83.0% respectively. Combined antibiotic and β-lactam inhibitor gave lower resistance rates than antibiotic alone (piperacillin/tazobactam, cefoporazone/sulbactam and ampicillin/sulbactam were 4.1%, 10.8% and 52.0% respectively, P<0.01). Of 148 E.coli isolates, 38 strains were capable of yielding extended-spectrum beta-lactamases (ESBLs) (25.7%), 110 strains were not able to produce ESBLs (74.3%) and the resistance rates of isolates with ESBLs to 28 antibiotics were significantly lower than those of isolates without ESBLs. Conclusion Antibiotic/β-lactam inhibitor and nitrofurantoin are effective for urogenital infections caused by E.coli.

中图分类号:

R978.1

崔伟历, 徐德兴, 李文玲, 王露霞. 大肠埃希菌所致泌尿生殖系感染的细菌耐药分析[J]. 南方医科大学学报, 2004, 24(08): 940-942,945.

CUI Wei-li, XU De-xing, LI Wen-ling, WANG Lu-xia. Analysis of anti-microbial resistance of Escherichia coli that caused infection in urogenital system[J]. Journal of Southern Medical University, 2004, 24(08): 940-942,945.

参考文献

[1] 唐明忠,刘娟,王美容.尿中大肠埃氏希菌耐药特性的调查[J].中华医院感染学杂志(Chin Hosp Infec J),1998,3(8):119-20.
[2] National Committee for Clinical Laboratory Standards (NCCLS).Performance standards for antimicrobial susceptibility testing[J].Ninth Informational Supplement M 100-S11,2001, 21: 1-122.
[3] Li JT, Weinstein A J, Yang M, et al. Surveillance of bacterial resistance in China (1998～1999)[J]. 中华医学杂志(Natl Med J Chin)2001, 81(1): 8.
[4] 张亚莉,耿穗娜,赖福才,等.常见病原菌对环丙沙星的耐药现状[J].第一军医大学学报,2002,22(4):378-9.Zhang YL, Geng SN, Lai FC, et al. Survey on drug resistance to ciprofloxacin in common pathogenic bacteria[J]. J Firs Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao, 2002, 22(4): 378-9.
[5] 冯玉华,崔维韵,李奇志,等.泌尿系感染大肠埃希氏菌耐药性分析[J].天津药学(Tianjing Pharmaco),2002,14(6):69-70.
[6] 王露霞,石凌波,徐德兴,等.应用纸片扩散法与梯度浓度法测定不动杆菌属的耐药性[J].第一军医大学学报,2003,23(5):469-71.Wang LX, Shi LB, Xu DX, et al. Assay ofAcinetobacter SPP drug-resistance by Kirby-Bauer and Etest method[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao, 2003, 23(5): 469-71.
[7] Jacoby GA, Medeiros AA. More extended-spectrum β-1actamases[J]. Antimicrob Agents Che mother, 1991, 35(9): 1697
[8] Pogne DJ, Amyes SGB. Transferable resistance to extended spectrum β-1actams:a major threat or a minor inconvenience[J]? J Antimicrob Chemother, 1991, 27(2): 255.
[9] Medeiros AA. Evolution and dissemination ofbeta-lactamases accelerated by generation of beta-lactam antibiotics[J]. Clin infect Dis,1997, 24(Suppl 1): S19.
[10] Philippon A, Labia R, Jacoby G. Extended-spectrum beta-lactamases[J]. Antibim icrob Agents Chem other, 1989, 33:1131.
[11] Firere J, Guiney D. Extended-spectrum beta-lactamases[J]. J Am Med Assos, 1999, 281: 563.
[12] Jacoby GA, Hah P. Detection of extended-spectrum beta-lactam ases in clinical is o lates ofK lebsiella p neumoniae and E scherichia coli[J]. J Clin Microbiol, 1996, 34: 908.