儿童产超广谱β-内酰胺酶痢疾杆菌的耐药性和基因分型  

Drug Resistance and Gene Type of Extended Spectrum β-Lactamases-Producing Dysentery Bacilli in Children

作　　者：杨道坤[1] 梁海军[1] 崔艳慧[2] 乔汉臣[1] 

机构地区：[1]新乡医学院第一附属医院感染1科,河南卫辉453100 [2]新乡医学院第一附属医院肿瘤科,河南卫辉453100

出　　处：《实用儿科临床杂志》2010年第10期739-740,750,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的了解本地区儿童感染产超广谱β-内酰胺酶(ESBLs)痢疾杆菌的耐药基因分型和耐药性的变化。方法收集本院细菌性痢疾患儿分离鉴定的痢疾杆菌株120株,采用美国国家临床检验标准委员会(NCCLS)推荐的双纸片协同法确认产ESBLs菌株30株,应用NCCLS推荐的纸片扩散法测定产ESBLs痢疾杆菌对氨苄西林、阿莫西林克拉维酸、美洛西林舒巴坦、头孢唑啉、头孢呋辛、头孢噻肟、头孢他啶、头孢哌酮舒巴坦、头孢吡肟、氨曲南、头孢西丁、亚胺培南、庆大霉素、阿米卡星、环丙沙星、左氧氟沙星、加替沙星、司帕沙星、复方磺胺甲唑等19种抗生素的耐药性,并应用PCR方法对ESBLs基因进行分型。结果 120株痢疾杆菌中检出产ESBLs痢疾杆菌株30株,检出率为25%。产ESBLs痢疾杆菌对氨苄西林、阿莫西林克拉维酸、美洛西林舒巴坦、头孢唑啉、头孢呋辛、头孢噻肟、头孢他啶、头孢哌酮舒巴坦、头孢吡肟、氨曲南、头孢西丁、亚胺培南、庆大霉素、阿米卡星、环丙沙星、左氧氟沙星、加替沙星、司帕沙星、复方磺胺甲唑等抗菌药物耐药率分别为100.0%、53.3%、50.0%、93.3%、86.6%、73.3%、56.6%、53.3%、60.0%、63.3%、50.0%、0、83.3%、66.7%、13.3%、10.0%、6.7%、16.7%、90.0%。单独携带TEM型基因株占43.3%,单独携带SHV型基因株占13.3%,携带2种基因株占26.6%。结论产ESBLs痢疾杆菌检出率较高,具有多重耐药的特点;产ESBLs痢疾杆菌主要携带TEM型和SHV型β-内酰胺酶基因,其中绝大部分为产TEM型β-内酰胺酶。Objective To investigate the current resistant status and gene type of extended spectrum β-lactamases（ESBLs）-producing dysentery bacilli in children in Xinxiang Region.Methods There were 120 dysentery bacilli strains isolated in clinic,and 30 ESBLs-producing strains were detected by double-disk synergy test,the test was recommended by the National Committee for Clinical Laboratory Standards（NCCLS）.The susceptibility of 30 strains of ESBLs-producing dysentery bacilli to 19 antibiotics were detected by disk diffusion.There were ampicillin,amoxicillin-clavalanse,mezlocillin-sulbactam,cefazolin,cefuroxime,cefotaxime,ceftazidime,cefoperazone-sulbactam,cefepime,aztreonam,cefoxitin,imipenem,gentamicin,amikacin,ciprofloxacin,levofloxacin,gatifloxacin,sparfloxacin,sulfamethoxazole and trimethoprim,the disk diffusion test was recommended by NCCLS.The DNA of ESBLs-producing dysentery bacilli were genetyped by polymerase chain reaction.Results There were 30 ESBLs-producing isolates with a positive rate of 25%（30/120 strains）.The resistant rates of 30 strains of ESBLs-producing dysentery bacilli to ampicillin,amoxicillin-clavalanse,mezlocillin-sulbactam,cefazolin,cefuroxime,cefotaxime,ceftazidime,cefoperazone-sulbactam,cefepime,aztreonam,cefoxitin,imipenem,gentamicin,amikacin,ciprofloxacin,levofloxacin,gatifloxacin,sparfloxacin,sulfamethoxazole and trimethoprim were 100.0%,53.3%,50.0%,93.3%,86.6%,73.3%,56.6%,53.3%,60.0%,63.3%,50.0%,0,83.3%,66.7%,13.3%,10.0%,6.7%,16.7%,90.0%.The results of PCR showed that the rates of TEM type,SHV type and TEM with SHV type in ESBLs-producing dysentery bacilli isolates were 43.3%,13.3% and 26.6%,respectively.Conclusions The incidence of ESBLs-producing dysentery bacilli isolates is higher than others,and which are multi-resistant.Most of the ESBLs-producing dysentery bacilli isolates carry TEM related genes or/and SHV related genes,and the TEM related genes are the most.

关 键 词：超广谱Β-内酰胺酶 痢疾杆菌 耐药性 基因分型 

分 类 号：R446.5[医药卫生—诊断学] R450[医药卫生—临床医学]