肿瘤专科医院临床和环境标本中产超广谱β-内酰胺酶大肠埃希菌流行病学调查  

The epidemiological investigation of extended-spectrum β-Lactamases-producing Escherichia coli in clinical and environmental samples at the tumor hospital

作　　者：许青霞 潘军 孙明月 沈勇 常彦敏 肖伟强 

机构地区：[1]郑州大学附属肿瘤医院检验科,450008

出　　处：《中华传染病杂志》2015年第8期490-493,共4页Chinese Journal of Infectious Diseases

基　　金：河南省科技厅重点科技攻关资助项目（112102310256）

摘　　要：目的了解肿瘤专科医院临床和环境标本中产超广谱伊内酰胺酶（ESBL）大肠埃希菌的基因型及同源性。方法检测2012年6月至2013年1月郑卅l大学附属肿瘤医院住院患者的临床标本（St液、尿液、痰液、胸腔积液、腹腔积液、引流液、粪便等）和环境标本（空气、陪护者手、门把手、床扶手、床头柜、医护人员手）中产ESBL大肠埃希菌，经表型确认试验确定ESBL的表型，多重PCR检测blatzEM、blasnv、blaoxn、blaDTX和blarox等基因型，脉冲场凝胶电泳（PFGE）分析临床标本和环境标本中菌株的同源性。结果表型确认试验检测到临床标本和环境标本中共有产ESBL大肠埃希菌41株，其中临床标本中有36株（为28例患者的临床标本），环境标本中有5株。多重PCR检测ESBL基因，单一型别ESBL菌株以携带TEM-1基因型和CTX14基因型为主；两种型别ESBI．菌株以携带CTX-14、TEM-1基因型为主；三种型别ESBL菌株同时携带CTX-14、TEM-1和SHV—1基因型。PFGE结果显示，28例患者的粪便和其他临床标本中产ESBL大肠埃希菌之间没有同源性，外科一病区3例患者及其中1例患者的床头柜上检出产ESBL大肠埃希菌有同源性。结论郑州大学附属肿瘤医院产ESBL大肠埃希菌主要流行的基因型为TEM-1、CTX-14、CTX-1。同一菌株可具有多种基因型别，以两种型别为主。外源性感染是产ESBL大肠埃希菌感染途径之一。Objective To analyze the genotypes of extended-spectrum β-Lactamases （ESBL）- producing Escherichia coli （E. cold and its homology from the clinical and environmental samples at the tumor hospital. Methods The clinical samples （including the patientr s blood, urine, sputum, hydrothorax, drainage fluid, stool, etc） and environmental samples （including the air, escort hand, door handles, bed rails, bedside table, medical staff hand） were collected at the Tumor Hospital Affiliated to Zhengzhou University from June 2012 to January 2013. The confirmatory test of ESBL phenotype was performed. 13 Lactamase genes （blaTEM, blasHv, blaoxA, bLacTx and blaFox were detected by multiplex polymerase chain reaction （PCR） assays. Pulsed-field gel electrophoresis （PFGE） was used to characterize the homology of all the strains. Results The phenotypic confirmatory test detected a total of 41 ESBL- producing E. coli, among which 36 stains were from clinical specimens （all were from 28 patients） and 5 strains from environmental specimens. Meanwhile, multiplex PCR detection of the genes of ESBL- producing E. coli was performed. TEM-1 or CTX-14 type was predominant in ESBL-producing E. coli carrying one gene. Those carrying two genes were mainly CTX-14 and TEM-1 genes, whereas three genes were CTX-14, TEM-1 and SHV-1. PFGE results showed that the specimens from 28 patients that located in gut or other clinical specimens shared no homology in ESBL-producing E. colL However, the specimens from 3 patients and 1 patientls bedside table in the first surgical ward shared homology.Conclusions The major epidemic genes of E. coli in our hospital were TEM-1, CTX-14 and CTX-1. The same strain may have many genotypes, mainly with two genes. Exogenous infection may be one major way in ESBL-producing E. coli infection.

关 键 词：肠产毒性大肠杆菌 Β内酰胺酶类 脉冲场凝胶电泳 

分 类 号：R446.5[医药卫生—诊断学]