产超广谱β-内酰胺酶大肠埃希菌所致社区获得性血流感染特征分析  

Analysis of community-associated bloodstream infections caused by Escherichia coli producing extended-spectrum β-lactamase

作　　者：李晓军[1] 邓明惠 张波[3] 候轩[2] 陶俊奇 王辉[2] 周梦蓉 张微[2] 李晓波[2] 辜依海[1] 

机构地区：[1]西安交通大学医学院附属三二○一医院口腔颌面外科,陕西省汉中市723000 [2]西安交通大学医学院附属三二○一医院微免科,陕西省汉中市723000 [3]西安交通大学医学院附属三二○一医院骨科,陕西省汉中市723000

出　　处：《中华医学杂志》2015年第26期2084-2089,共6页National Medical Journal of China

摘　　要：目的 比较社区获得性与医院获得性产超广谱β-内酰胺酶（ESBLs）大肠埃希菌血流感染危险因子和耐药性特征,为更好地制定针对社区获得性耐药大肠埃希菌感染的防控策略提供依据.方法 收集2008年11月至2013年9月西安交通大学医学院附属三二○一医院51例产ESBLs大肠埃希菌血流感染病例和菌株;采用K-B纸片法进行19种抗菌药物的药敏、ESBLs确认试验;脉冲场凝胶电泳（PFGE）进行菌株同源性分析;PCR扩增测序筛选ESBLs基因型;核酸酶S1酶切包埋菌株再进行PFGE的方法评估大肠埃希菌携带质粒的数量和大小.结果 51例病例社区获得性为27例,医院获得性24例;社区获得性感染患者呈逐年增多的趋势;尿路感染和肿瘤在社区和医院获得性患者之间差异有统计学意义,尿路感染的病例以社区获得性感染患者为主（OR=18.40,95％ CI：2.161 ～ 156.7）;而肿瘤患者以医院获得性感染患者为主（OR=0.147 7,95％ CI：0.034 85 ～0.62630）;菌株PFGE同源性分析显示,无论是社区获得性菌株还是医院获得性菌株,均呈散发克隆的分布;51株菌株中,TEM基因型26株,社区菌株包括12株,SHV基因型12株,社区菌株5株,CTX-M-1基因型21株,社区菌株10株,CTX-M-9基因型25株,社区菌株13株,所有ESBLs耐药基因型分布在两组中差异均无统计学意义.结论 尿路感染是社区获得性大肠埃希菌所致血流感染的相对危险因子;社区获得性血流感染产ESBLs大肠埃希菌耐药性与医院获得性菌株耐药程度接近,控制社区获得性产ESBLs大肠埃希菌感染与传播非常有必要.Objective To compare the risk factors and resistance characterizations between the Community-associated （CA） and Hospital-associated （HA） bloodstream infections （BSIs） caused by extended-spectrum β-lactamase-producing （ESBLs） Escherichia coli.Infections control strategy must be made for the spread of CA E.Coli.Methods Fifty-one samples of ESBLs-producing BSI E.Coli were collected in 3201 hospital affiliated of Xi＇an jiaotong University School of Medicine from 2008 to 2013.Antimicrobial agents susceptibility test and ESBLs confirmation test were determined by K-B method.PFGE was used to investigate the clonality of clinical isolates.PCR amplification and sequencing were used to screen ESBLs genes.Plasmid conjugation assay was used by filter mating.An S1-PFGE assay on plasmid and southern blot were performed to determine the plasmid molecular size and resistance genes location.Results There were 27 community-associated samples,while 24 hospital-associated samples in 51.And patients with community-acquired infections were increasing year by year.Also there was a significant difference between patients with urinary tract infection and cancer in CA and HA.Cases of urinary tract infection were mainly CA,reaching to 18.40 of OR value,and from 2.161 to 156.7 of 95% confidence interval.While Cases of cancer gave priority to HA,OR value was 0.147 7 with 0.034 85 to 0.626 30 of 95% confidence interval.PFGE results did not support the evidence of clone dissemination.Among 51 strains,26 TEM genotype,including 12 CA strains,12 SHV genotype,including 5 CA strains,21 CTX-M-1 genotype,including 10 CA strains,and 25 CTX-M-9 genotype.including 13 CA strains.All ESBLs resistant genotypes were no significant differences in the two groups.Conclusions Urinary tract infection is risk factor for community-aassociated bloodstream infection caused by E.Coli relatively.Degree of drug resistance of ESBLs-producing E.Coli isolated from Community-Associated Bloodstream Infections is close to Hospital-Associated.So the public

关 键 词：血流感染 危险因子 耐药性 脉冲凝胶电泳 质粒 

分 类 号：R446.5[医药卫生—诊断学]