Background. Emergence of pathogenic bacteria carrying β-lactamase-resistant determinants has become a major health problem in the hospital setting. The study aimed to determine antibiotic-resistant patterns and frequency of extended-spectrum β-lactamase- (ESBL-) producing Gram-negative bacteria (GNB) and AmpC β-lactamase-producing GNB. Methodology. A prospective cross-sectional study was conducted during a period from September 2017 to August 2018 at King Abdullah Hospital, Bisha Province, Saudi Arabia. GNB (n = 311) were recovered from patients’ clinical specimens including sputum, urine, wound pus, blood, tracheal aspirates and high vaginal swabs, umbilical discharge, eye discharge, and cerebrospinal fluids. Isolates were identified by the Phoenix identification system. Antimicrobial susceptibility was tested by the Kirby–Bauer disk procedure. Phenotypic characterization of ESBLs and AmpC β-lactamases was performed utilizing the double-disk synergy test and inhibitor-based method, respectively. Associations with outcome measures were determined by simple descriptive statistics and a chi-square test. Results. Out of 311 GNB isolates, the frequency of ESBL and AmpC β-lactamase producers was 84 (27%) and 101 (32.5%), respectively. Klebsiella pneumoniae and Escherichia coli were common ESBL producers. AmpC β-lactamases predominate among Acinetobacter spp. and Pseudomonas aeruginosa. Coproduction of ESBLs and AmpC β-lactamases was found in 36 (11.6%) isolates, with very close relative frequencies among K. pneumoniae, Acinetobacter spp., and P. aeruginosa. β-Lactamase producers were predominantly found in the surgical department (56.5%) and ICUs (44.2%). ESBL producers revealed high resistance for cefuroxime (96.4%), cefotaxime (92.9%), and trimethoprim/sulfamethoxazole (90.5%). The resistance rates were significantly higher among ESBL producers than nonproducers for cephalosporins (), amoxicillin/clavulanate (), piperacillin/tazobactam (), nitrofurantoin (), aztreonam (), ciprofloxacin (), and trimethoprim/sulfamethoxazole (). Significantly higher () resistance rates were observed among AmpC β-lactamase producers than nonproducers for all tested antibiotics. Conclusions. This finding showed a high prevalence of ESBL- and AmpC β-lactamase-producing GNB in our hospital. Quality control practice and routine detection of β-lactamase producers before deciding on antibiotic therapy are advocated.

中文翻译：

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沙特阿拉伯转诊医院中产生超广谱 β-内酰胺酶和 AmpC β-内酰胺酶的革兰氏阴性菌的表型特征和抗生素耐药性模式。

背景。携带β-内酰胺酶抗性决定簇的病原菌的出现已成为医院环境中的主要健康问题。该研究旨在确定产生超广谱β -内酰胺酶 (ESBL-) 的革兰氏阴性菌 (GNB) 和产生 AmpC β -内酰胺酶的 GNB 的抗生素耐药模式和频率。方法论。一项前瞻性横断面研究于 2017 年 9 月至 2018 年 8 月期间在沙特阿拉伯比沙省阿卜杜拉国王医院进行。GNB ( n = 311）从患者的临床标本中回收，包括痰液、尿液、伤口脓液、血液、气管吸出物和高位阴道拭子、脐带分泌物、眼睛分泌物和脑脊液。分离株由 Phoenix 识别系统识别。通过 Kirby-Bauer 圆盘法测试抗菌药物敏感性。分别利用双盘协同试验和基于抑制剂的方法对 ESBL 和 AmpC β -内酰胺酶进行表型表征。通过简单的描述性统计和卡方检验确定与结果测量的关联。结果。在 311 个 GNB 分离物中，ESBL 和 AmpC β -内酰胺酶产生者的频率分别为 84 个（27%）和 101 个（32.5%）。肺炎克雷伯菌和大肠杆菌是常见的 ESBL 生产者。AmpC β-内酰胺酶在不动杆菌属中占主导地位。和铜绿假单胞菌。在 36 个 (11.6%) 分离物中发现了 ESBL 和 AmpC β-内酰胺酶的共生，在肺炎克雷伯菌、不动杆菌属和铜绿假单胞菌中的相对频率非常接近。β- 内酰胺酶生产者主要存在于外科（56.5%）和重症监护室（44.2%）。ESBL 生产商显示对头孢呋辛 (96.4%)、头孢噻肟 (92.9%) 和甲氧苄啶/磺胺甲恶唑 (90.5%) 具有高耐药性。ESBL 生产者对头孢菌素（）、阿莫西林/克拉维酸（）、哌拉西林/他唑巴坦（）、呋喃妥因（）、氨曲南（）、环丙沙星（）和甲氧苄啶/磺胺甲恶唑（）的耐药率显着高于非生产者。在 AmpC β中观察到显着更高的 ( )电阻率-所有测试抗生素的内酰胺酶生产者高于非生产者。结论。这一发现表明，我们医院产 ESBL 和 AmpC β -内酰胺酶的 GNB 的患病率很高。提倡在决定抗生素治疗之前进行质量控制实践和常规检测β-内酰胺酶生产者。