脑卒中患者医院感染大肠埃希菌耐药情况及耐药基因序列分析  

Analysis of drug resistance and sequencing of drug resistance genes of Escherichia coli causing nosocomial infections in stroke patients

作　　者：杨元[1] 马丽[2] 袁正洲[1] 李作孝[1] 

机构地区：[1]泸州医学院附属医院神经内科,四川泸州646000 [2]泸州医学院附属医院药物临床试验机构办公室

出　　处：《中国病原生物学杂志》2014年第7期595-598,669,共5页Journal of Pathogen Biology

摘　　要：目的通过对住院脑卒中患者感染的大肠埃希菌耐药基因序列进行研究,了解其耐药现状,以指导脑卒中患者的临床用药。方法从住院脑卒中患者的临床标本中分离大肠埃希菌,进行药敏试验,按标准计算各分离株对抗菌药物的敏感率、中介率、耐药率;对分离菌进行耐药基因PCR扩增,通过凝胶电泳记录结果。结果分离株大肠埃希菌对22种抗菌药物的敏感率从高到低顺序为:TZP 100%、SCF 100%、IMP 100%、MEM 100%、AK 94.4%、ATM90.7%、FEP 90.7%、CAZ 83.3%、FOX 74.1%、NET 72.2%、K 61.1%、F 61.1%、CTX 51.9%、CXM 50.0%、TOB44.4%、KF 42.6%、CN 27.8%、OFX 24.0%、LEV 24.0%、NOR 24.0%、CIP 24.0%、PIP 14.8%。检测大肠埃希菌部分耐药基因,包括CTX-M-1基因、aac(3)-I基因、aac(3)-II基因、aac(6)-I基因、aac(6)-II基因、TEM基因、SHV基因、qnr基因、qacE△1-sull基因、VEB基因、PER基因以及CARB基因,其中CTX-M-1基因、TEM基因、SHV基因、aac(3)-II基因、qacE△1-sull基因阳性率分别为:16.7%、29.6%、9.3%、7.4%和70.4%。结论住院脑卒中患者感染的大肠埃希菌多重耐药情况严重,并且耐药机制复杂,应根据药敏试验结果合理选用抗菌药物治疗。Objective To determine the current drug resistance of Escherichia coli by studying sequences of drug resistance genes of E.coli infecting stroke patients in order to better guide the clinical treatment of stroke patients. Methods E.coli was isolated from clinical specimens from hospitalized stroke patients to perform a drug susceptibility test.In accordance with standards,the susceptibility,intermediate resistance,and resistance of each isolate to antimicrobials were calculated.Drug resistance genes were amplified with PCR.Gel electrophoresis was performed and results were recorded. Results The isolated strain of E.coli＇was tested for resistance to 22 types of antibiotics.Susceptibility to TZP was100%,susceptibility to SCF was 100%,susceptibility to IMP was 100%,susceptibility to MEM was 100%,susceptibility to AK 94.4%,susceptibility to ATM was 90.7%,susceptibility to FEP was 90.7%,susceptibility to CAZ was83.3%,susceptibility to FOX was 74.1%,susceptibility to NET was 72.2%,susceptibility to K was 61.1%,susceptibility to F was 61.1%,susceptibility to CTX was 51.9%,susceptibility to CXM was 50.0%,susceptibility to TOB was44.4%,susceptibility to KF was 42.6%,susceptibility to CN was 27.8%,susceptibility to OFX was 24.0%,susceptibility to LEV was 24.0%,susceptibility to NOR was 24.0%,susceptibility to CIP was 24.0%,and susceptibility to PIP was 14.8%.Drug resistance genes of E.coli were detected and included the CTX-M-1gene,aac（3）-I gene,aac（3）-II gene,aac（6）-I gene,aac（6）-II gene,TEM gene,SHV gene,qnr gene,qacE△1-sull gene,VEB gene,PER gene,and CARB gene.Isolates tested positive for these genes at a rate of 16.7%,29.6%,9.3%,7.4%,and 70.4%. Conclusion Multidrug-resistant E.coli infecting hospitalized stroke patients is highly prevalent and the mechanism of drug resistance is very complex,so clinicians should choose antibiotics more rationally in accordance with the results of drug susceptibility testing.

关 键 词：脑卒中 感染 大肠埃希菌 耐药基因 

分 类 号：R378.21[医药卫生—病原生物学]