儿童医院超广谱β-内酰胺酶大肠埃希菌的基因型与耐药性分析  

Genotyping of extended-spectrum β-lactamase-producing Escherichia coli in children and analysis of drug resistance

作　　者：李静[1] 王洛平[1] 徐英春[2] 徐文健[1] 杨启文[2] 肖盟[2] 王会萍[1] 孟春[1] 秦小平[1] 

机构地区：[1]首都儿科研究所附属儿童医院检验科,北京100020 [2]北京协和医院检验科,北京100032

出　　处：《中华医院感染学杂志》2013年第18期4354-4356,共3页Chinese Journal of Nosocomiology

基　　金：首都儿科研究所科研基金项目(所-2011-A14)

摘　　要：目的探讨儿童专科医院主要临床标本分离出的ESBLs大肠埃希菌基因型和耐药性特点,为应对产ESBLs大肠埃希菌的院内暴发流行寻找可靠的试验证据和抗菌药物选择。方法收集2008年1月-2011年12月首都儿科研究所附属儿童医院住院患儿的痰液、血液、尿液与支气管肺泡灌洗液标本分离出的产ESBLs大肠埃希菌,进行PCR扩增分析基因型,同时对扩增产物进行DNA序列分析确定基因亚型。结果 109株表型产ESBLs大肠埃希菌中,100株ESBLs基因分型均表达为CTX-M型,基因亚型共发现8种,前3位为CTX-M-14、CTX-M-55和CTX-M-15亚型,其余9株基因型为单一TEM-1β-内酰胺酶基因;产ESBLs大肠埃希菌对亚胺培南敏感率100.0%,CTX-M-1组和CTX-M-9对头孢他啶的耐药率分别为90.7%和13.3%。结论儿童医院感染性培养标本分离出的产ESBLs大肠埃希菌以CTX-M型为主,产ESBLs菌株呈多药耐药,不同基因组间头孢他啶的耐药率有明显差异,碳青霉烯类抗菌药物可作为儿科治疗产ESBLs大肠埃希菌耐药株的首选药物。OBJECTIVE To investigate the genotypes and the antibiotic resistance of extended -spectrum β-lactamase （ESBL）-producing Escherichia coli in children so as to provide reliable evidence for the control of outbreak and prevalence of ESBL-producing E. coli and reasonably used antibiotics. METHODS The children who were hospitalized from Jan 2008 to Dec 2011 were enrolled in the study, then the ESBL-producing E. coli strains isolated from the sputum, blood, urine, or bronchoalveolar lavage fluid were collected for the analysis of genotypes with PCR amplification, then the DNA sequencing was performed for the amplified products to determine the genotype. RESULTS Among 109 strains of ESBL-producing Escherichia coli, 100 strains were CTX-M genotype. Totally 8 genotypes were found, CTX-M-14, CTX-M-55 and CTX-M-15 were the predominant genotypes, and the rest of 9 strains were with the single TEM-1 i？-lactamases. The drug susceptibility rate of the ESBL-producing E. coli to imipenem was 100.0% ; the drug resistance rates of the strains in the CTX-M-1 group and the CTX-M-9 group to ceftazidime were 90.7 % and 13.3 %, respectively. CONCLUSION CTX-M genotype is the predominant genotype of ESBL-producing E. coli isolated from the clinical specimens of the children with infections, while the ESBL-producing strains are multidrug-resistant. The strains vary significantly in the drug resistance to eeftazidime, and car bapenems can be used as the preferred for the treatment of ESBL-produeing E. coli infections.

关 键 词：患儿 大肠埃希菌 超广谱Β-内酰胺酶 基因型 耐药性 

分 类 号：R378.21[医药卫生—病原生物学]