[1]杨宏斌,张 妍.甘肃省天水地区产ESBLs大肠埃希菌致尿路感染的基因分型及耐药性分析[J].现代检验医学杂志,2019,34(03):55-58，61.[doi:10.3969/j.issn.1671-7414.2019.03.013]
　YANG Hong-bin,ZHANG Yan.Genotyping and Drug Resistance Analysis of UrinaryTract Infection Caused by ESBLs-producing Escherichia coliin Tianshui Area of Gansu Province[J].Journal of Modern Laboratory Medicine,2019,34(03):55-58，61.[doi:10.3969/j.issn.1671-7414.2019.03.013]
点击复制

甘肃省天水地区产ESBLs大肠埃希菌致尿路感染的基因分型及耐药性分析()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年03期
页码:
55-58，61
栏目:
论著
出版日期:
2019-06-20

文章信息/Info

Title:
Genotyping and Drug Resistance Analysis of UrinaryTract Infection Caused by ESBLs-producing Escherichia coliin Tianshui Area of Gansu Province
文章编号:
1671-7414(2019)03-055-05
作者:
杨宏斌; 张 妍
(天水市中医医院检验科,甘肃天水 741000)
Author(s):
YANG Hong-bin; ZHANG Yan
(Department of Clinical Laboratory,Tianshui Hospital of Traditional Chinese Medicine,Gansu Tianshui 741000,China)
关键词:
尿路感染;  大肠埃希菌;  基因型;  ESBLs;  携带模式;  耐药性
分类号:
R378.21; R446.5
DOI:
10.3969/j.issn.1671-7414.2019.03.013
文献标志码:
A
摘要:
目的 了解天水地区尿路感染患者产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的基因型分布和耐药性特征,为尿路感染的用药选择和院感防控提供参考。方法 收集该地区尿培养分离的2 126株大肠埃希菌,用基质辅助激光解吸电离飞行时间质谱仪(MALDI-TOF)进行鉴定,采用K-B法进行药物敏感试验,按照美国临床实验室标准化委员会(CLSI 2017)推荐的ESBLs纸片扩散法进行表型确证试验,1 003株产ESBLs的大肠埃希菌提取其耐药质粒,应用PCR法检测blaCTX-M,blaTEM,blaSHV及blaOXA耐药基因表型。结果 ①尿培养分离的2 126株大肠埃希菌中产ESBLs菌株1 003株,产酶率为47.2%,科室分布以泌尿外科最多,检出475株,占47.4%,其次是内分泌科,检出216株,占21.5%。②ESBLs大肠埃希菌对临床常用抗生素如青霉素类、1～3代头孢菌素、单环类、氟喹诺酮类和磺胺类的耐药率超过80%,较非产酶株耐药率高,差异均有统计学意义(P<0.01,P<0.05)。仅对碳青霉烯类、磷霉素和呋喃妥因耐药率<5%。③ESBLs大肠埃希菌耐药基因分子分型特征为:(1)blaCTX-M基因型624株占62.2%,blaTEM基因型287株占28.6%,blaSHV基因型51株占5.1%,blaOXA基因型30株占3.0%,阴性4株占0.4%,未见其它表型。其中blaCTX-M表型以blaCTX-M-14亚型为主,检出597株,占59.5%,其次为bla CTX-M-15亚型,检出21株,占2.1%,blaCTX-M-3亚型最少,检出6株占0.6%;(2)携带单一模式992株,占98.9%,同时携带两种不同耐药基因的复合模式7株,占0.7%,分别为:blaCTX-M-14+ bla-TEM型4株,占0.4%,blaCTX-M-15+ bla-TEM型2株,占0.2%,blaCTX-M-3+ bla-TEM型1株,占0.1%。结论 天水地区致尿路感染产ESBLs大肠埃希菌呈现多重耐药性,耐药基因以blaCTX-M-14亚型为主,其次为bla-TEM型; 菌株以携带单一模式为主,可见同时携带两种耐药基因型的复合模式; 建议临床应根据药敏试验结果选择用药,并加强院感监测与有效的隔离措施,防控耐药菌株在该地区的水平播散。
Abstract:
Objective To understand the genotype and drugresistance of ESBLs Escherichia coli in patients with urinary tract infection in Tianshui area,and provide reference for the treatment of clinical urinary tract infections and the prevention and control of nosocomial infection.Methods 2 126 strains of Escherichia coli isolated from urine culture were collected and identified by matrix-assisted laser desorptionionization time-of-flight mass spectrometry(MALDI-TOF).Drug susceptibilitytests were carried out by K-B method.Phenotypic confirmation tests were carried out by ESBLs disk diffusion method recommended by CLSI 2017.1 003 strains ofESBLs-producing Escherichia coli were isolated and their resistant plasmids were identified.The phenotypes of blaCTX-M,blaTEM,blaSHV and blaOXA resistance genes were detected by PCR.Results ①Among 2 126 strains of Escherichia coli isolated from urine culture,ESBLs 1 003 strainswere produced,accounting for 47.2%.Urology was the most detected strain,accounting for 47.4%,followed by endocrinology(mainly diabetes patients),accounting for 21.6%.②The resistance rate of ESBLs Escherichia coli to commonclinical antibiotics such as penicillins,cephalosporins of the first,second and third generations,aztreonam,fluoroquinolones and compound sulfamethoxazole was over 80%,which was higher than that of non-enzyme-producing strains(P<0.05,P<0.01).The resistance rate to carbapenems,fosfomycin and furans waslower than 5%.③Molecular typing of ESBLs-producing Escherichia coli resistance genes was as follows:(1)624 strains of blaCTX-M genotype accounted for 62.2%,287 strains of blaTEM genotype accounted for 28.6%,51 strains of blaSHVgenotype for 5.1%, 30 strains of blaOXA genotype accounted for 3.0%,and 4 negative strains accounted for 0.4%.BlaCTX-M phenotype was mainly blaCTX-M-14,597 strains(59.5%)were detected,followed by blaCTX-M-15,21 strains(2.1%)were detected,blaCTX-M-3 subtype was the least,6 strains(0.6%)werefound,and no other phenotypes were found.(2)992 strains(98.9%)were carryinga single mode,while 7 strains(0.7%)were carrying two different drug-resistant genes at the same time,they were:4 strains of blaCTX-M-14 + bla-TEM accounted for 0.4%,2 strains of blaCTX-M-15+bla-TEM accounted for 0.2%,1 strains of blaCTX-M-3+bla-TEM accounted for 0.1%。Conclusion Escherichia coli producing ESBLs from urinary tract infections in Tianshui area showed multiple drug resistance,with CTX-M-14 subtype as the dominant drug resistance gene and TEM subtype as the second.The strains carried a single mode,which showed that they carried two drug resistance genotypes at the same time.It was suggested that clinical drug use should be selected according todrug sensitivity test results,and hospital infection monitoring and effectiveisolation measures should be strengthened to prevent and control drug-resistantstrains in this area.Horizontal dissemination in the region.

参考文献/References:

[1] 中华人民共和国国家卫生和计划生育委员会.WS/T489-2016尿路感染临床微生物实验室诊断[S].北京:中国标准出版社,2016. National Health and Family Planning Commission of People's Republicof China.WS/T489-2016 Laboratory diagnosis of urinary tract infection[S].Beijing:China Standard Press,2016.
[2] 宫海燕,李劭昱,杨珊珊,等.2014～2015年ESBLs阳性和ESBLs阴性大肠埃希菌临床分布及其耐药性的分析[J].国际检验医学杂志,2017,38(15):2030-2033. GONG Haiyan,LI Shaoyu,YANG Shanshan,et al.Clinical distributionand drug resistance of ESBLs-producing and non ESBLs-producing Escherichiacoli isolated from 2014 to 2015[J].International Journal of Laboratory Medicine,2017,38(15):2030-2033.
[3] Clinical and Laboratory Standands Institude.CLSI Mo 2-A9 Performance standands for antimicrorbial disk susceptinility tests,Approved standand ten edition[S].Wayne:PA,CLSI Mo2-A9,2016.
[4] 周思彤,王永胜,袁红霞,等.产超广谱β-内酰胺酶大肠杆菌耐药质粒提取方法的研究和比较[J].中国卫生检验杂志,2015,25(13):2099-2101. ZHOU Sitong,WANG Yongsheng,YUAN Hongxia,et al.Research and comparison of several methods for extract ESBLs-producing resistant Escherichia coli plasmid[J].Chinese Journal of Health Inspection,2015,25(13):2099-2101.
[5] 陈菲,曹小利,程莉,等.尿培养产CTX-M大肠埃希菌的种系分型及耐药和毒力特点分析[J].现代检验医学杂志,2016,31(2):12-14,19. CHEN Fei,CAO Xiaoli,CHENG Li,et al.Analysis on the resistance and virulence characteristics and phylogenetic groups of CTX-M-producing Escherichia coli isolated from urine[J].Journal of Modern Laboratory Medicine,2016,31(2):12-14,19.
[6] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251. HU Fupin,GUO Yan,ZHU Demei,et al.Antimicrobial resistance profile of clinical isolates in hospital across China:report from the CHINET surveillance program 2017[J].Chinese Journal of Infection and Chemotherapy,2018,18(3):241-251.
[7] 严海忠,王娟,卢兰芬,等.糖尿病患者感染产ESBLs肠杆菌科细菌的耐药性及危险因素分析[J].现代检验医学杂志,2018,33(5):82-86. YAN Haizhong,WANG Juan,LU Lanfen,et al.Analysis of the drug resistance and risk factors of ESBLs-producing Enterobacteriaceae infection indiabetics[J].Journal of Modern Laboratory Medicine,2018,33(5):82-86.
[8] 周华,李光辉,陈佰义,等.中国产超广谱β-内酰胺酶肠杆菌细菌感染应对策略专家共识[J]中华医学杂志,2014,94(24):1847-1856. ZHOU Hua,LI Guanghui,CHEN Baiyi,et al.Expert consensus on strategies to cope with bacterial infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases in China[J].National Medical Journal ofChina,2014,94(24):1847-1856.
[9] 唐进春,杨淑雅,赵瑞珂,等.医院获得性尿路感染大肠埃希菌ESBLs基因型与耐药性分析[J].检验医学与临床,2016,13(6):734-737,740. TANG Jinchun,YANG Shuya,ZHAO Ruike,et al.Analysis on ESBLs genotypes and drug resistance of hospital-acquired uropathogenic E.coli[J].Journal of Laboratory Medicine and Clinical Medicine,2016,13(6):734-737.
[10] 韩松涛,曾德鹏,徐梅,等.产超广谱β-内酰胺酶大肠埃希菌耐药机制研究[J].检验医学与临床杂志,2016,13(12):638-640. HAN Songtao,ZENG Depeng,XU Mei,et al.Research on antibiotic resistance of Escherichia coli producing ESBLs[J].Journal of Laboratory and Clinical,2016,13(12):638-640.
[11] 徐学静,曹小利,张之烽,等.血培养大肠埃希菌的药物敏感性分析研究及ESBLS编码基因的流行性分析[J].现代检验医学杂志,2016,31(1):55-57.XU Xuejing,CAO Xiaoli,ZHANG Zhifeng,et al.Analysis on the antimicrobial susceptibilities and the prevalence of encoding genes of Escherichia coliisolates collected from blood[J].Journal of Modern Laboratory Medicine,2016,31(1):55-57.
[12] 周杰,徐康立,张鲍虎,等.产超广谱β-内酰胺酶大肠埃希菌耐药性及基因型分析[J].蚌埠医学院学报,2018,43(8):1060-1063.ZHOU Jie,XU Kangli,ZHANG Baohu,et al.Analysis of drug resistance and genotype of ESBLs-producing Escherichia coli[J].J Bengbu Med Coll,2018,43(8):1060-1063.
[13] 陈云芬,董亚琼,陈芳,等.大肠埃希菌产超广谱β-内酰胺酶中产CTX-M-1型变异菌株的基因分析[J].贵州医药,2018,42(4):404-405.CHEN Yunfen,DONG Yaqiong,CHEN Fang,et al.Analysis of gene sequence ofCTX-M-1 type extended spectrum β-lactamase producing Escherichia coli isolated[J].Guizhou Medical Journal,2018,42(4):404-405.
[14] 覃新芳,伍民生,邹迪莎,等.产超广谱β-内酰胺酶大肠埃希菌致尿路感染的影响因素及病原菌耐药情况[J].广西医学; 2018,40(21):2577-2580.QIN Xinfang,WU Minsheng,ZOU Disha,et al.Influencing factors of urinarytract infection caused by extended-spectrum β-lactamase-producing Escherichia coli and its pathogens drug resistance[J].Guangxi Medical Journale,2018,40(21):2577-2580.

相似文献/References:

[1]陈 菲,曹小利,程 莉,等.尿培养产CTX-M大肠埃希菌的种系分型及耐药和毒力特点分析[J].现代检验医学杂志,2016,31(02):12.[doi:10.3969/j.issn.1671-7414.2016.02.004]
　CHEN Fei,CAO Xiao-li,CHENG Li,et al.Analysis on the Resistance and Virulence Characteristics and Phylogenetic Groups of CTX-M-Producing Escherichia Coli Isolated from Urine[J].Journal of Modern Laboratory Medicine,2016,31(03):12.[doi:10.3969/j.issn.1671-7414.2016.02.004]
[2]刘志远,潘 健,齐 杰,等.黄芩苷对一株产NDM-1 大肠埃希菌体内外抗菌作用的研究[J].现代检验医学杂志,2016,31(03):124.[doi:10.3969/j.issn.1671-7414.2016.03.035]
　LIU Zhi-yuan,PAN Jian,QI Jie,et al.Anti-bacterial Effects of Baicalin on One Escherichia coli Strain Carrying NDM-1 Gene[J].Journal of Modern Laboratory Medicine,2016,31(03):124.[doi:10.3969/j.issn.1671-7414.2016.03.035]
[3]靳占奎a,王 曦,杨 乐,等.重组人肿瘤坏死因子hTNF-α在大肠埃希菌[E.coli BL21DE3]中表达条件的优化[J].现代检验医学杂志,2017,32(05):100.[doi:10.3969/j.issn.1671-7414.2017.05.017]
　JIN Zhan-kuia,WANG Xi,YANG Le,et al.Optimization of Expression of Recombinant Human Tumor Necrosis Factor(hTNF-α)in Escherichia coli[E.coli BL21(DE3)][J].Journal of Modern Laboratory Medicine,2017,32(03):100.[doi:10.3969/j.issn.1671-7414.2017.05.017]

备注/Memo

备注/Memo:
基金项目:天水市科技局科技支撑项目(项目编号:2018y010)。 作者简介:杨宏斌(1978-),男,大学本科,主管检验师,主要从事细菌耐药性研究,E-mail:gstsyhb7788@sina.com。 收稿日期:2019-02-26修回日期:2019-04-11
更新日期/Last Update: 2019-06-20