与植入物感染相关大肠埃希菌的耐药特征  

Resistance characteristics of Escherichia coli associated with implant infection

作　　者：钱雪峰[1] 史进方[1] 邱善敏[1] 顾国浩[1] 

机构地区：[1]苏州大学附属第一医院检验科,江苏省临床免疫学重点实验室,江苏省苏州市215006

出　　处：《中国组织工程研究与临床康复》2010年第48期8950-8953,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:生物材料植入人体后,往往会发生感染引起植入物松动、脱落甚至造成菌血症。以往研究未注重植入物相关感染中的细菌耐药性问题。目的:了解与植入物感染相关大肠埃希菌的耐药特征,为预防和更有效治疗该类感染提供策略。方法:以大肠埃希菌ATCC25922、金黄色葡萄球菌ATCC25923和铜绿假单胞菌ATCC27853为质控菌株,选取17种临床常用抗生素进行药敏试验,计算耐药率,分析耐药特征。用表型确证试验筛选产AmpC酶和产ESBLs菌株,明确产酶率。抽提耐药质粒,以聚合酶链反应扩增检测耐药基因,分析基因型分布情况。结果与结论:17种抗生素中耐药率最低的是亚胺培南,其次为阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟,大部分菌株对其他抗生素均有较高耐药率,且呈多重耐药。筛选出42株(61.8%)产ESBLs菌株和27株(39.7%)产AmpC酶菌株,同时产ESBLs和AmpC酶菌株有23株(33.8%)。产ESBLs菌株中以携带CTX-M型基因最为多见占66.7%,有19株(45.2%)同时携带两种以上基因,产AmpC酶中大多数是产DHA型,有5株(18.5%)同时携带两种基因。提示与植入物感染相关的大肠埃希菌菌株耐药水平高、耐药谱扩大,且多呈多重耐药,耐药基因复杂多样。建议使用敏感药物联合阿米卡星治疗该类感染。BACKGROUND：Implantation of biomaterials can induce infection,resulting in implant loosening,shedding,even bacteremia.Previous studies do not focus on bacterial drug resistance in implant-related infection.OBJECTIVE：To investigate the resistance characteristics of implant infection-associated Escherichia coli to provide strategies for prevention and treatment of this infection.METHODS：With E.coli ATCC 25922,Staphylococcus aureus ATCC 25923 and Pseudomonas aeruginosa ATCC 27853 as quality control strain,17 commonly used antibiotics were selected to perform susceptibility test.The resistance rates were calculated to analyze resistance characteristics;disc screen test and disc diffusion phenotypic confirmatory test were used to detect strains producing Amp C and ESBLs,a clear enzyme production rate;resistance plasmid was extracted.Drug resistance genes were detected by PCR expansion.Genotype distribution was analyzed.RESULTS AND CONCLUSION：Of 17 antibiotics,imipenem resistance rate was the lowest,followed by amikacin,cefoperazone/sulbactam,cefepime and piperacillin/tazobactam,and most were multi-drug resistant strains.A total of 42 strains（61.8%）were screened and produced ESBLs and 27 isolates（39.7%）Amp C production strains,while producing ESBLs and Amp C strains were 23（33.8%）.ESBLs producing strains carrying CTX-M type gene were the most common accounting for 66.7%,19 strains（45.2%）carrying two or more genes.Of producing Amp C production,the majority of strains were DHA-type,and 5 strains（18.5%）carried two genes.Implant infection of Escherichia coli strains showed high levels of resistance,resistance spectrum to expand,and multiple drug resistance.The drug resistant gene is complex and diverse.Sensitive drugs in combination with amikacin are recommended to treat this kind of infection.

关 键 词：大肠埃希菌 植入物 细菌生物膜 耐药特征 ESBLS AMPC 

分 类 号：R318[医药卫生—生物医学工程]