抗菌药物对下呼吸道产酶肠杆菌体外活性研究
Study of in vitro antimicrobial activities of antibiotics to producing β-lactamases enterobacteriaceae from lower respiratory tract
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摘要: 目的: 了解下呼吸道常见肠杆菌科细菌产β内酰胺酶状况;测定几种抗菌药物对产酶菌的体外抗菌活性。方法: 采用头孢西丁三维试验检测AmpC酶;NCCLS推荐的纸片扩散确证法检测ESBLs;二倍琼脂稀释法测定药物的体外抗菌活性;K B琼脂扩散法行药敏试验。结果: 在所收集的80株下呼吸道标本中,阴沟肠杆菌39株,其中25.6%产ESBLs、41.0%产AmpC酶、7.7%同时产AmpC和ESBLs;其次是肺炎克雷伯菌和大肠埃希菌。7种氟喹诺酮类药物中,环丙沙星、诺氟沙星、氧氟沙星和培氟沙星对产酶菌的耐药率较高在50%以上,莫西沙星、加替沙星和左氧氟沙星的耐药率较低在30%~40%之间。在其他4种常用抗生素中,伊米配能的耐药率低,对ES BLs、AmpC和ESBLs+AmpC菌株的耐药率分别为16.7%、9.5%和0;阿米卡星的耐药率在30%~40%之间;头孢噻肟和头孢他啶的耐药率最高,多数在70%以上。结论: 临床分离的下呼吸道标本中,阴沟肠杆菌最多且产酶率最高;几种抗菌药物中伊米配能具有较高抗菌活性;其次是莫西沙星、加替沙星、左氧氟沙星和阿米卡星。Abstract: Objective: To investigate the production of β-lactamases in enterobacteriaceae from lower respiratory tract and measure the antimicrobial activities in vitro of several antibiotics to enzyme-producing strains.Methods: Cefoxitin three-dimensional test and disk diffusion confirmation method recommended by NCCLS were used to detect AmpC enzyme and ESBLs respectively. Antimicrobial activity in vitro and sensitivity of drugs were measured by twofold agar dilution method and kirby-bauer agar diffusion method respectively. Results: Among 80 clinical isolates there were 39 strains enterobacter cloacae, 25.6% of those produced ESBLs, 41.0% for AmpC enzyme and 7.7% for ESBLs+AmpC;then followed by klebsiella pneumoniae and escherichia coli. In seven fluoroquinolones resistance rates of ciprofloxacin, norfloxacin, ofloxacin and pefloxacin were higher than that of moxifloxacin, gatifloxacin and levofloxacin, the former was over 50% and the latter was in 30%-40% to enzyme-producing strains. In other four common antibiotics resistance rate of imipenem was lower, 16.7%, 9.5% and 0 to ESBLs, AmpC and ESBLs+AmpC strains respectively. Resistance rate of amikacin was in 30%-40%, and that of cefotaxime and ceftazidime were highest, over 70%. Conclusions: Enterobacter cloacae was number one and had the highest anzyme-producing rate in clinical specimens from lower respiratory tract. Imipenem had higher antimicrobial activity; the next were moxifloxacin, gatifloxacin, levofloxacin and amikacin in several antibacterial drugs.
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