阴沟肠杆菌、奇异变形杆菌 AmpC 酶和ESBLs 的检测及其耐药性研究

摘要

目的：了解本地区阴沟肠杆菌、奇异变形杆菌 AmpC 酶和 ESBLs 的流行分布及对临床常用抗菌药物的耐药情况，为临床合理用药提供依据。方法阴沟肠杆菌和奇异变形杆菌的鉴定及药敏使用西门子 MicroScan WALK-AWAY96全自动细菌鉴定及药敏分析系统进行，采用酶提取物三维试验方法检测 AmpC 酶，使用表型确证试验纸片扩散法测定 ESBLs。结果76株阴沟肠杆菌中，产 AmpC 酶菌株为15株（19．74％），产 ESBLs 菌株为24株（31.58％），同时产两种酶的菌株为11株（14．47％）。43株奇异变形杆菌中，产 AmpC 酶菌株为7株（16．28％），产ESBLs 菌株为18株（41．86％），同时产两种酶的菌株为6株（13．95％）。对其药敏结果分析显示产 AmpC 酶和 ES-BLs 的菌株耐药性明显高于不产酶菌株。结论产 AmpC 酶和 ESBLs 是阴沟肠杆菌和奇异变形杆菌产生耐药的重要机制，碳青霉烯类药物是治疗这两种细菌感染的首选药物。%Objective To investigate the production of AmpC enzyme and ESBLs in Gram-negative bacilli and their drug-resistance to provide basis for reasonable use of antibiotics in clinical practice.Methods Identification and drug susceptibility of Enterobacter cloacae and Proteus mirabilis were performed by Siemens MicroScan WALKAWAY 96. AmpC and ESBLs were determined by three dimensional test and a phenotypic confirmatory test respectively.Results Among 76 Enterobacter cloacae strains,15 (19.74%) of them were detected to produce AmpC β-lactamase,24 (31.58%)of them were detected to produce ESBLs,11 (14.47%)of them were detected to produce AmpCβ-lactamase and ESBLs.Among 43 Proteus mirabilis strains ,7(16.28%)of them were detected to produce AmpCβ-lactamase,18 (41.86%)of them were detected to produce ESBLs,6 (13.95%)of them were detected to produce AmpCβ-lactamase and ESBLs.The drug susceptibility testing result indicated that the drug resistance rate of enzyme-producing strains was higher than that of the non-enzyme-producing strains.Conclusion AmpCβ-lactamase and ESBLs have been a criti-cal cause of the drug-resistance in Enterobacter cloacae and Proteus mirabilis .Carbapenems can be the first choice to treat Enterobacter cloacae and Proteus mirabilis infections.