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目的调查2013年1-8月同济医院门诊尿路感染中产超广谱β内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的耐药性及耐药机制。方法采用琼脂稀释法检测100株菌对19种抗菌药物的最低抑菌浓度;对ESBLs阳性菌株进行ESBLs基因、Amp-C酶基因、质粒介导的喹诺酮耐药基因及16SrRNA甲基化酶基因进行测定。结果细菌ESBLs的发生率为57%,所有菌株对亚胺培南、美罗培南及粘菌素均敏感;ESBLs阳性菌对19种抗生素的耐药率为0~100%,ESBLs阴性菌为0~48.8%;在57株ESBLs阳性菌株中,CTX-M-14型33株,CTX-M-15型26株,TEM-1型28株,OXA-1型8株,SHV-11型与SHV-12型各1株;Amp-C酶基因阳性菌中DHA-1型2株,CMY-2型2株;质粒介导的喹诺酮耐药基因阳性菌中aac(6′)-Ib-cr型32株,qnrB型4株;16SrRNA甲基化酶基因阳性菌中rmtB型3株,armA型1株。结论 CTX-M型、TEM型以及aac(6′)-Ib-cr型是同济医院社区获得性尿路感染中产ESBLs菌株的主要流行基因型。
Objective To investigate the drug resistance and drug resistance mechanism of Escherichia coli and Klebsiella pneumoniae producing mid-stage extended-spectrum β-lactamases (ESBLs) in Tongji Hospital from January to August 2013. Methods The minimum inhibitory concentration (MIC) of 100 antimicrobial agents against 100 strains of bacteria was determined by agar dilution method. ESBLs, Amp-C, plasmid-mediated quinolone resistance genes and 16SrRNA methylase genes Determination. Results The incidence of bacterial ESBLs was 57%. All strains were sensitive to imipenem, meropenem and colistin. The resistance rates of ESBLs to 19 antibiotics ranged from 0% to 100%, and ESBLs negative bacteria was 0 ~ 48.8%. Among the 57 ESBLs positive strains, 33 strains of CTX-M-14, 26 strains of CTX-M-15, 28 strains of TEM-1 and 8 strains of OXA- 12 type strains, 2 strains of DHA-1 type and 2 strains of CMY-2 type in Amp-C gene positive bacterium; aac (6 ’) - Ib-cr type 32 4 strain of qnrB and 3 strains of rmtB and 1 strain of armA in 16SrRNA methylase positive bacteria. Conclusion CTX-M type, TEM type and aac (6 ’) - Ib-cr type are the major epidemic genotypes of ESBLs-producing strains in community-acquired urinary tract infection in Tongji Hospital.