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目的探讨肺结核患者并发粘质沙雷菌肺部感染的耐药现状及ESBLs、AmpC酶、碳青霉烯酶的检测率,指导临床合理使用抗菌药物。方法收集2011年1月至2015年6月从缙云县人民医院肺结核并发粘质沙雷菌肺部感染患者的痰液标本中分离的74株粘质沙雷菌,K-B纸片法进行药敏试验,采用双纸片确证试验进行ESBLs检测、头孢西丁三维试验法检测AmpC酶、改良Hodge试验筛选碳青霉烯酶,利用WHONET 5.6软件分析药敏试验数据。结果药敏试验表明粘质沙雷菌对氨苄西林、头孢唑林、头孢呋辛、氨曲南的耐药率较高,耐药率均大于60.0%,对妥布霉素、亚胺培南、美罗培南、阿米卡星、丁胺卡那霉素的耐药率较低,耐药率均小于10.0%;在74株粘质沙雷菌中,共有21株产ESBLs,检出率为28.4%;产AmpC酶15株,检出率为20.3%,同时产ESBLs和AmpC酶细菌6株,占8.1%;对美罗培南耐药的菌株5株,改良Hodge试验阳性株4株,阳性率为5.4%。结论从肺结核患者分离出的粘质沙雷菌多重耐药率高,耐药机制复杂,耐药性的产生与产ESBLs、AmpC酶、碳青霉烯酶有关,临床应根据药敏试验结果合理用药。
Objective To investigate the drug resistance of pulmonary tuberculosis complicated with S. marcestris and the detection rate of ESBLs, AmpC and carbapenema in patients with pulmonary tuberculosis, and to guide the rational use of antibacterials in clinic. Methods From January 2011 to June 2015, 74 strains of Serratia marcescens isolates from sputum from patients with Pulmonary tuberculosis complicated with Serratia marcescens in Jinyun People’s Hospital were tested for antibiotic susceptibility by KB disk method , ESBLs test was performed with double disc confirmatory test, AmpC enzyme was tested by cefoxitin three-dimensional test, carbapenemase was modified by modified Hodge test, and susceptibility test data were analyzed by WHONET 5.6 software. Results The results of drug susceptibility test showed that the drug resistance rates of Serratia marcescens to ampicillin, cefazolin, cefuroxime and aztreonam were all higher than those in the susceptible strains, and the rates of resistance were all above 60.0%. The resistance to tobramycin, imipenem , Meropenem, amikacin and amikacin had lower resistance rate, and the resistance rates were less than 10.0%. Among the 74 strains of Serratia marcescens, 21 strains were ESBLs-producing, the detection rate was 28.4%; 15 strains of AmpC produced with the detection rate of 20.3%; 6 strains of ESBLs and AmpC producing bacteria, accounting for 8.1%; 5 strains resistant to meropenem; 4 strains improved Hodge test, the positive rate 5.4%. Conclusion The drug-resistant rate of Serratia marcescens isolated from patients with pulmonary tuberculosis is high, the mechanism of drug resistance is complex, and the drug resistance is related to the production of ESBLs, AmpC and carbapenemases. The clinical results should be reasonable according to the susceptibility test Medication.