CAJ | 학술논문

目的:联合应用抗生素测定并鉴别大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌产生的超广谱和Ⅰ型β-内酰胺酶。方法:用头孢噻肟（CTX）、头孢他定（CTD）、氨曲南（ATN）、奥格门丁（ AOA）、头孢西丁（CXT）和亚胺培能在MH琼脂上进行双纸片搭桥法检测和鉴别大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌的超广谱β-内酰胺酶(ESBLs)及Ⅰ型β-内酰胺酶。结果:265株大肠埃希菌、95株肺炎克雷伯菌、67株阴沟肠杆菌均对亚胺培能敏感；对三代头孢菌素的耐药率分别为23.4%、36.8%、58.2%,产生的能水解超广谱β-内酰胺类抗生素的β-内酰胺酶可分为两类，这些菌株对CXT有不同的耐药性；CTX+CTD+ATN的ES BLs检出率与单一CTX、CTD、ATN的检出率差异有显著性，与CTX+CTD的ESBLs检出率差异无显著性（P>0.05）。结论:应用不同抗生素可将水解超广谱β-内酰胺类抗生素的β-内酰胺酶分为ESBLs和Ⅰ型，有不同的耐药特点；联合应用两种以上抗生素可提高检出率，双纸片搭桥法适合临床使用，临床分离菌株应将超广谱和Ⅰ型β-内酰胺酶的检测作为常规。
목적:연합응용항생소측정병감별대장애희균 、폐염극뢰백균、음구장간균산생적초엄보화Ⅰ형β-내선알매。방법:용두포새우（CTX）、두포타정（CTD）、안곡남（ATN）、오격문정（ AOA）、두포서정（CXT）화아알배능재MH경지상진행쌍지편탑교법검측화감별대장애희균、 폐염극뢰백균、음구장간균적초엄보β-내선알매(ESBLs)급Ⅰ형β-내선알매。결과:265주대장애희균、95주폐염극뢰백균、67주음구장간균균대아알배능 민감；대삼대두포균소적내약솔분별위23.4%、36.8%、58.2%,산생적능수해초엄보β-내선 알류항생소적β-내선알매가분위량류，저사균주대CXT유불동적내약성；CTX+CTD+ATN적ES BLs검출솔여단일CTX、CTD、ATN적검출솔차이유현저성，여CTX+CTD적ESBLs검출솔차이무현 저성（P>0.05）。결론:응용불동항생소가장수해초엄보β-내선알류항생소적β-내선알매 분 위ESBLs화Ⅰ형，유불동적내약특점；연합응용량충이상항생소가제고검출솔，쌍지편탑교 법괄합림상사용，림상분리균주응장초엄보화Ⅰ형β-내선알매적검측작위상규。
Objective：Detection for extended-spectrum β-lactamases（ESBLs） and Ⅰtype β-lactam ase s from Eschrichia coli Klebsiella pneumoniae Enterobacter cloacae using varie d antibiotics.Methods：ESBLs and Ⅰtype β-lactamases from E.coli,K.pneumonia e and E.cloacae was detected by double-disk(DD) potentiation procedure and rule v itro-sensitive test.Cefotaxime(CTX), ceftazidime(CTD),aztreonam(ATN),augmentin( AOA),cefoxitin(CXT) and imipenem were used in this test.Results：Imipenem is sensitive for all strain at this test.23.4% Eschrichia coli 36.8% Klebsiella pneumoniae,and 58.2% Enterobacter cloacae res isted 3rd cephalosporins, the resistance for cefoxitin is different. The　β -lac tamases of hydrolyses extended-spectrum β-lactams is divided into two types.Th e rate of detection was higher by using CTX and CTD and ATN than using CTD or CT X or ATN only(χ2=5.14，P<0.05、χ2=21.04，P<0 .01、χ2=62.02，P <0.01),but not different from using CTX and CTD（χ2=0.5，P>0.05）.Conclusion：The ESBLs and Ⅰtype β-lactamases could be differe nt by using varied antibiotics,they have different resistance to antibiotics . U sing more than two　β-lactams antibiotis, the positive rate of ESBLs isolate i s r aised The double-disk(DD) method is practical for clinical detection of ESBLs- produ cing isolates of Enterobateriaceae. The detection of ESBLs and Ⅰtype β-lactam ases should be conducted for clinical isolate