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目的调查医院柠檬酸杆菌属感染的菌群分布、产酶的特性和对抗菌药物的耐药性,分析其多药耐药(MDR)特点,指导临床用药。方法对临床分离147株柠檬酸杆菌属,采用三维试验检测超广谱β-内酰胺酶(ESBLs)和AmpC酶,用双纸片协同试验检测金属β-内酰胺酶(MBL),并使用K-B纸片琼脂扩散法测定其对15种抗菌药物的耐药性。结果柠檬酸杆菌属医院感染以弗氏柠檬酸杆菌为主,其次是无丙二酸柠檬酸杆菌,ICU的分离率与内、外科、其他病区相比差异无统计学意义(P>0.05);呼吸道与泌尿道感染率相近,明显高于其他部位(P<0.01);柠檬酸杆菌属总分离株的ESBLs、AmpC、同产ESBLs和AmpC、MBL检出率分别为36.05%、10.20%、7.48%和2.72%,总分离株对亚胺培南、美罗培南的耐药率分别为4.76%、3.40%,其次是对头孢哌酮/他唑巴坦为23.81%;对其余抗菌药物的耐药率均>40.00%;非ICU和ICU多药耐药菌分别占53.64%和81.08%,两组病房差异有统计学意义(P<0.01)。结论医院感染的柠檬酸杆菌属ESBLs产酶率高,且大多呈多药耐药,亚胺培南、美罗培南、头孢哌酮/他唑巴坦对其具有良好的抗菌活性。
Objective To investigate the distribution of bacteria in Citrobacter nosocomial infection, the characteristics of enzyme producing and the drug resistance to antibacterial drugs, analyze the characteristics of multidrug resistance (MDR) and guide the clinical medication. Methods 147 strains of Citrobacter were isolated clinically. Extended-spectrum β-lactamase (ESBLs) and AmpC β-lactamase (ESBLs) and AmpC β-lactamases were detected by three-dimensional assay. Metal β-lactamase (MBL) The agar diffusion method was used to determine the resistance of 15 kinds of antibacterials. Results Citrobacter nosocomial infection was mainly Citrobacter freundii followed by Citrobacter malonate. There was no significant difference in ICU isolation rate between the ICU and other wards (P> 0.05) (P <0.01). The detection rates of ESBLs, AmpC, isogenic ESBLs, and AmpC and MBL in the total isolates of Citrobacter were 36.05% and 10.20% respectively, the rates of respiratory tract and urinary tract infection were significantly higher than those of other sites 7.48% and 2.72% respectively. The resistance rates of the total isolates to imipenem and meropenem were 4.76% and 3.40% respectively, followed by 23.81% for cefoperazone / tazobactam. The resistance to the remaining antibiotics The drug rates were> 40.00%. The multi-drug resistant strains in non-ICU and ICU accounted for 53.64% and 81.08%, respectively. The differences between the two groups were statistically significant (P <0.01). Conclusions The nosocomial infection rate of Citrobacter ESBLs is high and most of them are multi-drug resistant. Imipenem, Meropenem and cefoperazone / tazobactam have good antibacterial activity.