泌尿系感染病原菌中产超广谱β-内酰胺酶大肠埃希菌耐药特征及基因分型  

Drug resistance and genotyping of extended-spectrum β-lactamase-producing Escherichia coli among pathogens causing urinary tract infections

作　　者：潘玫[1] 李稳[1] 陈山[2] 刘泉[1] 张玉倩[1] 

机构地区：[1]山东中医药大学附属医院检验科,山东济南250011 [2]山东省立医院,山东济南250012

出　　处：《中华医院感染学杂志》2013年第21期5134-5136,5142,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81000869)

摘　　要：目的了解医院泌尿系感染病原菌中产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的CTX-M型、TEM型、SHV型基因流行状况及耐药特征,阐明其ESBLs亚型分布及耐药性。方法采用双纸片法检测产超广谱β-内酰胺酶,聚合酶链反应(PCR)检测CTX-M型、TEM型、SHV型基因型,K-B法进行药敏试验。结果 59株尿源性大肠埃希菌中,33株ESBLs表型阳性,PCR扩增结果显示,CTX-M型基因扩增阳性为23株占69.7%,TEM型阳性11株占33.3%,SHV型仅1株占3.0%;产ESBLs大肠埃希菌,除亚胺培南、美罗培南未见耐药外,呋喃妥因、阿米卡星、哌拉西林/他唑巴坦、头孢西丁耐药性较低,不敏感率(耐药+中介)分别为9.1%、12.1%、18.2%、30.3%,产ESBLs大肠埃希菌,除了对头孢菌素、单环β-内酰胺类抗菌药物具有很高耐药性外,对磺胺甲噁唑/甲氧苄啶、庆大霉素、左氧氟沙星、环丙沙星具有较高耐药性,不敏感率依次为75.8%、75.8%、72.8%、66.7%。结论产ESBLs大肠埃希菌基因型以CTX-M组为主,且呈现多药耐药趋势。OBJECTIVE To investigate the prevalence of genotypes of CTX-M, TEM, and SHV in extendedspectrum β-lactamase （ESBLs）-producing Escherichia coli among the pathogens causing urinary tract infections and analyze the drug resistance so as to define the ESBLs subtypes and the drug resistance. METHODS The extended-spectrum β-lactamases were detected with the use of dual disk diffusion method, the genotypes, including CTX-M, TEM, and SHV, were tested by using polymerase chain reaction （PCR）, and the drug susceptibility testing was performed with the use of K-B method. RESULTS Of totally 59 strains of E. coli isolated from urine specimens, 33 strains were positive for ESBLs phenotype; the result of PCR amplification indicated that there were 23 （69.7%） strains with CTX-M gene, 11 （33. 3%） strains with TEM gene, and 1 （3.0%） strain with SHV gene. The drug resistance rates of the ESBLs-producing E. coli strains to imipenem and meropenem were 0, and the drug resistance or intermediary rates to nitrofurantoin, amikacin, piperacillin-tazobactam, and cefepime were 9.1%, 12.1%, 18.2 %, and 30.3 %, respectively; the ESBLs-producing E. coli strains were highly resistant to β-lactams, the drug resistance or intermediary rates to trimethoprim-sulfamethoxazole, gentamicin, levofloxacin, and ciprofloxacin were 75.8%,75.8% ,72.8%, and 66.7%, respectively. CONCLUSION The CTX-M gene is the predominant genotype in the ESBLs-producing E. coli strains, showing a trend of multidrug-resistance.

关 键 词：泌尿系 大肠埃希菌 超广谱Β-内酰胺酶 基因型 

分 类 号：R378[医药卫生—病原生物学]