摘要：
OBJECTIVE:To provide reference for rational drug use and hospital infection control. METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan. 2011-Oct. 2017. Drug sensitivity test was conducted by using MIC. The situation of AmpC enzyme production was confirmed by three dimensional test, and that of ESBLs-producing stain was detected with double-disk synergy test. RESULTS:There were 546 strains of AmpC enzyme-producing E. cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80% of non-sputum specimen (546/11 375)and 38.97% of E. cloacae(546/1 401). Top 3 non-sputum samples in the list of detection rate were wound secretion (27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%), neurosurgery department(18.68%)and general surgery department(16.67%). Resistance rate of AmpC enzyme-producing E. cloacae to most commonly used antibiotics was higher than 40%. There was statistical significance in resistant rate of the bacteria to ceftriaxone, cefotaxime, gentamicin, nitrofurantoin, levofloxacin, piperacillin/tazobactam, cefoperazone, ceftazidime,cefepime,tobramycin and minocycline among different years (P40%,其中不同年度该菌对头孢曲松、头孢噻肟、庆大霉素、呋喃妥因、左氧氟沙星、哌拉西林/他唑巴坦、头孢哌酮、头孢他啶、头孢吡肟、妥布霉素、米诺环素的耐药率比较,差异均有统计学意义(P<0.05);但对亚胺培南、美罗培南的耐药率<2%.546株产AmpC酶阴沟肠杆菌中,共检出产ESBLs菌株68株,其2011-2017年的检出率依次为5.77%、6.06%、8.70%、10.26%、13.79%、17.35%、18.75%.结论:该院产AmpC酶阴沟肠杆菌主要来自于伤口分泌物、中段尿等标本,且集中于ICU、神经外科等科室.该菌耐药情况严峻,对β-内酰胺类、喹诺酮类等抗菌药物的耐药率上升明显;产ESBLs菌株的检出率逐年上升;但对碳青霉烯类抗菌药物敏感,可将其作为经验首选药物.临床应加强产AmpC酶阴沟肠杆菌耐药及产酶情况的监测,并结合药敏试验结果合理选用抗菌药物,以阻止或延缓其耐药率的快速上升.
