尿路感染ESBLs阳性大肠埃希菌的基因分型与耐药性分析  

Genotypes and Antibiotics Resistance Profiles of ESBLs Uropathogenic Escherichia Coli

作　　者：刘世巍[1] 徐杰[1,2,3] 张正芳[2,4] 王立平[2,4] 高光俊[2,4] 王玉飞[2] 苑锡铜[2] 黄留玉[2] 崔明全[2] 张宁[1] 陈永德[1] 陈泽良[2] 郭洁[1] 

机构地区：[1]中国中医研究院望京医院,北京100120 [2]军事医学科学院疾病预防控制所,北京100071 [3]吉林大学公共卫生学院医学基因组学研究中心,长春130021 [4]西南大学药学院,重庆400716

出　　处：《现代检验医学杂志》2012年第4期5-8,共4页Journal of Modern Laboratory Medicine

基　　金：国家自然基金项目（No.81071399）,国家重大专项（No.2009ZX10004-205）.

摘　　要：目的了解尿路感染ESBLs阳性大肠埃希菌的耐药和基因分型遗传特征，指导尿路感染的临床用药与控制医院感染。方法选取中国中医研究院望京医院2006～2010年医院分离的76株尿路感染大肠埃希菌，通过药敏试验分析这些菌株对17种抗生素的耐药性，用rep-PCR对菌株进行分型。结果选取的76株尿路感染大肠埃希菌对哌拉西林、庆大霉素、左氧氟沙星、头孢唑啉、头孢呋辛、氨苄西林／舒巴坦、头孢噻肟与头孢曲松的耐药率高达40％以上，依次是86％，68％，64％，59％，59％，41％，41％和40％。17种抗菌药物中，亚胺培南与美洛培南的耐药率最低，敏感率为100％，与ES—BLs阴性的大肠埃希菌相比，尿路感染ESBLs阳性大肠埃希菌有14种抗菌药物的耐药率高。76株尿路感染大肠埃希菌分为三个大的组，其中A组敏感性最高，B组次之，C组耐药性最强，舍有ESBLs的尿路感染大肠埃希菌主要分布在C组和B组。rep-PCR可以把76株菌分为68个基因型，四个组，分别为I，Ⅱ，Ⅲ和Ⅳ，分别包含25，14，20和17株细菌。不同基因型的菌株在耐药性上没有显著差异。结论尿路感染大肠埃希菌对常见的抗生素产生不同程度的耐药性，含有ESBLs的尿路感染大肠埃希菌的耐药性更高，这些菌株的耐药性可能是通过水平转移获得的。临床上应严格按照科学的用药方案进行抗生素使用，及时掌控ESBLs的尿路致病性大肠埃希菌对抗生素耐药的变化，以减少耐药性菌株的产生，降低耐药菌的危害。Objective To characterize the antibiotics resistance profiles and genotypes of ESBLs positive uropathogenic Esche- richia coli,and guide clinical antibiotics use. Methods A total of 76 uropathogenic Escherichia coli strains isolated from WanNing Hospital during 2006-2010 were selected for antibiotics resistance and rep-PCR genotyping. Results The resistance percent for piperacillin, gentamicin, levofloxacin, cefazolin, cefuroxime, ampicillin/sulbactam, cefotaxime and ceftriaxone were 86%,68%,64% ,59% ,59% ,41%,41% and 40% respectively. All the strains were 100% sensitive for Imipenem and Meropenem. ESBLs positive strains showed higher resistance to 14 of the 17 antibiotics. According to the resistance profiles, the 76 strains were divided into three groups, A, B and C,of which group A showed the highest resistance, followed by B and C. ESBLs positive strains were classified mainly in group C and B. All the 76 strains were genotyped into 68 genotypes and four groups, I , II, III and IV, which contained 25,14,20 and 27 strains respectively. No significant resistance difference were observed in these genotypes. Conclusion UPEC are resistant to commonly used antibiotics. ESBLs positive isolates showed higher resistance than negative ones. The resistancd＇ might be mainly acquired by horizontal gene transfer. Strict ad- herence to antibiotics use rules and timely grasp the distribution of ESBLs positive UPEC are important means for preven- tion of resistant strains.

关 键 词：超广谱Β-内酰胺酶 尿路感染大肠埃希菌 基因分型 耐药性 

分 类 号：R378.21[医药卫生—病原生物学] Q786[医药卫生—基础医学]