以色列特拉维夫医疗中心肠杆菌科细菌中广谱β-内酰胺酶的发生率及表型特征，以及诊断试验的评估
Occurrence and phenotypic characteristics of extended-spectrum beta-lactamases among members of the family Enterobacteriaceae at the Tel-Aviv Medical Center (Israel) and evaluation of diagnostic tests.
作者信息
Navon-Venezia Shiri, Hammer-Munz Orly, Schwartz David, Turner Dan, Kuzmenko Boris, Carmeli Yehuda
机构信息
Laboratory for Molecular Epidemiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
J Clin Microbiol. 2003 Jan;41(1):155-8. doi: 10.1128/JCM.41.1.155-158.2003.
We assessed the prevalence and phenotypic characteristics of extended-spectrum beta-lactamase (ESBL) producers among cefuroxime-resistant (CXM-R) (MIC > or = 32 micro g/ml) members of the family Enterobacteriaceae in our institution. The 438 CXM-R clinical isolates obtained from nonurine sources among inpatients were screened. ESBL production was confirmed by disk diffusion assay using cefpodoxime (CPD), cefotaxime (CTX), and ceftazidime (CTZ) with and without clavulanate (CLAV). A difference of > or =5 mm in the size of the zone of inhibition in the presence of CLAV for at least one of the agents was considered representative of the ESBL phenotype: 186 isolates (42.5%) were confirmed as ESBL producers. The isolates tested and the rates of ESBL producers were as follows: Klebsiella spp. (n = 81), 79%; Proteus spp. (n = 58), 62%; Escherichia coli (n = 64), 53%; Enterobacter spp. (n = 69), 42%; Serratia spp. (n = 70), 14%; Citrobacter spp. (n = 25), 24%; Providencia spp. (n = 21), 24%; Morganella spp. (n = 41), 5%; and Kluyvera (n = 3), 0%. The overall sensitivity of isolated ESBL confirmatory tests was 79% for CPD-CLAV, 66% for CTZ-CLAV, and 91% for CTX-CLAV. Sensitivities of CTZ-CLAV confirmatory tests for Klebsiella spp., Proteus spp., E. coli, and Enterobacter spp. were 84, 22, 76, and 62%, respectively, and those for CTX-CLAV were 95, 97, 94, and 83%, respectively. They were 90% for CPD-CLAV and CTZ-CLAV, 95% for CPD-CLAV and CTX-CLAV, and 100% for CTZ-CLAV and CTX-CLAV. ESBL production was highly prevalent among Enterobacteriaceae. Using resistance to CXM as an ESBL screening criterion is a suitable option in high-incidence areas where Klebsiella spp. are not the dominant ESBL producers. This screening criterion may simplify the screening test and improve its sensitivity, although at the price of testing more isolates. The CTX-CLAV combination confirmed ESBL producers better than the CTZ-CLAV combination, with sensitivity varying between species. Combined CTZ-CLAV and CTX-CLAV testing detected all these strains; CPD-CLAV provided no additional benefit.
我们评估了我院肠杆菌科中对头孢呋辛耐药（CXM-R）（MIC≥32μg/ml）菌株产超广谱β-内酰胺酶（ESBL）的流行情况及表型特征。对438株从住院患者非尿液来源分离得到的CXM-R临床菌株进行了筛查。采用头孢泊肟（CPD）、头孢噻肟（CTX）和头孢他啶（CTZ）分别与克拉维酸（CLAV）联合或不联合进行纸片扩散法检测以确认ESBL的产生。若至少有一种药物在加入CLAV后抑菌圈直径差异≥5mm，则认为具有ESBL表型：186株（42.5%）被确认为产ESBL菌株。检测的菌株及产ESBL菌株的比例如下：克雷伯菌属（n = 81），79%；变形杆菌属（n = 58），62%；大肠埃希菌（n = 64），53%；肠杆菌属（n = 69），42%；沙雷菌属（n = 70），14%；枸橼酸杆菌属（n = 25），24%；普罗威登斯菌属（n = 21），24%；摩根菌属（n = 41），5%；克吕韦拉菌属（n = 3），0%。分离的ESBL确证试验总体敏感性：CPD-CLAV为79%，CTZ-CLAV为66%，CTX-CLAV为91%。CTZ-CLAV确证试验对克雷伯菌属、变形杆菌属、大肠埃希菌和肠杆菌属的敏感性分别为84%、22%、76%和62%，CTX-CLAV的敏感性分别为95%、97%、94%和83%。CPD-CLAV与CTZ-CLAV联合检测的敏感性为90%，CPD-CLAV与CTX-CLAV联合检测的敏感性为95%，CTZ-CLAV与CTX-CLAV联合检测的敏感性为100%。ESBL在肠杆菌科中高度流行。在克雷伯菌属不是主要产ESBL菌的高发病区，以对CXM的耐药性作为ESBL筛查标准是一种合适的选择。该筛查标准虽会增加检测菌株数量，但可简化筛查试验并提高其敏感性。CTX-CLAV组合确证产ESBL菌株的效果优于CTZ-CLAV组合，且不同菌种的敏感性存在差异。CTZ-CLAV与CTX-CLAV联合检测可检出所有这些菌株；CPD-CLAV无额外优势。
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