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目的研究内分泌科患者大肠埃希菌感染现状及大肠埃希菌对临床常用抗生素的耐药性,为内分泌科患者大肠埃希菌感染的防治提供依据。方法收集本院2012年1月-12月内分泌科感染患者临床标本,分离出116株大肠埃希菌并进行鉴定,对产ESBLs大肠埃希菌进行确证试验;采用K-B纸片扩散法对大肠埃希菌进行药敏试验,根据美国临床实验室标准化委员会药敏试验标准2014版判读结果;采用PCR检测大肠埃希菌常见耐药基因。结果 116株大肠埃希菌中检出65株产ESBLs大肠埃希菌,占56.03%。产ESBLs大肠埃希菌株对临床常用的14种抗生素耐药程度依次为:哌拉西林90.77%,庆大霉素70.77%,卡那霉素69.23%,妥布霉素35.38%,阿米卡星12.31%,复方新诺明64.62%,头孢噻肟87.69%,头孢吡肟40.00%,头孢西丁13.85%,左氧氟沙星75.38%,环丙沙星69.23%,加替沙星16.92%,亚胺培南1.54%和美罗培南3.08%。产ESBLs大肠埃希菌TEM等耐药基因携带率为3.08%~90.76%,未检出OTA-2,OTA-51和NDM-1基因。讨论临床分离株产ESBLs大肠埃希菌对哌拉西林,头孢噻肟和左氧氟沙星耐药率>75%,因此上述3种药物不宜用于治疗产ESBLs大肠埃希菌感染。亚胺培南和美罗培南虽然对大肠埃希菌具有良好的治疗效果,但应控制使用,避免产生碳青霉烯耐药菌。
Objective To study the status of Escherichia coli (Escherichia coli) infection in endocrine patients and the resistance of Escherichia coli to commonly used antibiotics in clinic, and to provide basis for prevention and treatment of Escherichia coli infection in endocrinology patients. Methods A total of 116 clinical isolates of Escherichia coli were collected from January 2012 to December 2012 in our hospital. Escherichia coli ESBLs isolates were identified and identified. Escherichia coli producing ESBLs was confirmed by KB method. Fungus susceptibility test, according to the American Clinical Laboratory Standardization Committee susceptibility test standard interpretation of the results of the 2014 edition; PCR detection of Escherichia coli common resistance gene. Results Among 116 Escherichia coli strains, 65 strains of Escherichia coli producing ESBLs were detected, accounting for 56.03%. The antibiotic resistance of ESBLs-producing Escherichia coli strains to 14 commonly used antibiotics was as follows: piperacillin 90.77%, gentamycin 70.77%, kanamycin 69.23%, tobramycin 35.38%, amikacin 12.31%, 64.62% of cotrimoxazole, 87.69% of cefotaxime, 40.00% of cefepime, 13.85% of cefoxitin, 75.38% of levofloxacin, 69.23% of ciprofloxacin, 16.92% of gatifloxacin, 1.54% and Meropenem 3.08%. The carrying rate of TEM and other resistant genes producing ESBLs Escherichia coli was 3.08% -90.76%. OTA-2, OTA-51 and NDM-1 genes were not detected. The clinical isolates of ESBLs-producing Escherichia coli to piperacillin, cefotaxime and levofloxacin resistance rate of> 75%, so these three drugs should not be used for the treatment of ESBLs-producing Escherichia coli infection. Although imipenem and meropenem have good therapeutic effect on Escherichia coli, they should be controlled to avoid carbapenem-resistant bacteria.