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目的了解儿童非痰标本大肠埃希菌的分布特点及耐药性,为临床合理选用抗菌药物提供参考依据。方法收集2011年1月-2015年12月患儿非痰标本分离出的大肠埃希菌,采用Phoenix-100全自动细菌鉴定药敏系统进行鉴定并测定MIC,采用双纸片协同扩散法检测ESBLs,三维试验法检测AmpC;WHONET5.6和SPSS20.0软件对实验结果进行统计分析。结果 2011-2015年儿童非痰标本中共分离病原菌3 109株,其中大肠埃希菌421株,占病原菌总数13.54%,占肠杆菌科细菌52.09%;对头孢噻肟、美洛西林、磺胺甲噁唑/甲氧苄啶、氨苄西林、哌拉西林、四环素等常用抗菌药物耐药率较高,均>50.0%;仅对美罗培南、亚胺培南、哌拉西林/他唑巴坦等耐药率<10.0%;对头孢唑林、头孢曲松、头孢噻肟、庆大霉素、氨苄西林、哌拉西林、头孢克洛、美洛西林、头孢吡肟、妥布霉素、哌拉西林/他唑巴坦等抗菌药物的耐药率上升明显(P<0.05);ESBLs与AmpC酶检出率逐年上升(P<0.05)。结论患儿非痰标本分离的大肠埃希菌的ESBLs与AmpC酶检出率和耐药性逐年上升,临床应监测其耐药性变化,合理选择抗菌药物,减缓抗菌药物耐药性快速上升。
Objective To understand the distribution characteristics and drug resistance of Escherichia coli in children with non-sputum samples, and to provide a reference for rational use of antibacterials in clinic. Methods Escherichia coli isolated from non-sputum samples of children from January 2011 to December 2015 were collected and identified by the Phoenix-100 automatic bacterial identification drug-susceptible system. MICs were detected by double disc synergy diffusion assay , Three-dimensional test method AmpC; WHONET5.6 and SPSS20.0 software for statistical analysis of experimental results. Results A total of 3 109 strains of pathogens were isolated from non-sputum samples from 2011 to 2015, including 421 strains of Escherichia coli, accounting for 13.54% of the total number of pathogens, accounting for 52.09% of the total number of Enterobacteriaceae strains. Among the 109 cases of cefotaxime, mezlocillin, sulfamethoxazole The rates of resistance to commonly used antimicrobial agents such as azole / trimethoprim, ampicillin, piperacillin and tetracycline were all higher than 50.0%; only resistant to meropenem, imipenem and piperacillin / tazobactam The rate of drug was less than 10.0%; cefazolin, ceftriaxone, cefotaxime, gentamicin, ampicillin, piperacillin, cefaclor, mezlocillin, cefepime, tobramycin, (P <0.05). The detection rate of ESBLs and AmpC increased year by year (P <0.05). Conclusion The detection rate and drug resistance of ESBLs and AmpC in Escherichia coli isolated from non-sputum specimens of children are increasing year by year. The change of drug resistance should be monitored in clinic. The rational selection of antimicrobial agents should be used to slow down the rapid rise of antimicrobial resistance.