社区获得性尿道致病性大肠埃希菌毒力基因检测及其与预后的相关性研究  

Virulence Genes in Community-acquired Uropathogenic Escherichia coli and Its Correlation with the Prognosis of the Disease

作　　者：茅国峰[1] 骆振刚[2] 

机构地区：[1]浙江省绍兴市人民医院检验科,312000 [2]浙江省绍兴市人民医院泌尿外科,312000

出　　处：《中国全科医学》2017年第8期984-987,共4页Chinese General Practice

基　　金：浙江省科技厅公益技术应用研究项目(2014C33255)

摘　　要：目的了解社区获得性尿道致病性大肠埃希菌(UPEC)的毒力基因及耐药性,探讨毒力基因与疾病预后的相关性。方法收集2013—2014年于绍兴市人民医院治疗的尿路感染(UTI)患者56株社区获得性UPEC,采用纸片扩散法(K-B法)和微量稀释法进行药敏试验,按照美国临床与实验室标准协会(CLSI)制定的药敏试验标准(2014年版)判读药敏试验结果。PCR法检测P菌毛亚单位A(pap A)、细胞毒素坏死因子1(cnf1)、细胞毒素坏死因子2(cnf2)、定植因子抗原B(cfa B)、侵袭质粒抗原B(ipa B)、hof Q、omp T毒力基因,并结合临床资料分析患者的疾病进展和转归情况。结果 56株社区获得性UPEC共检测到omp T毒力基因阳性菌株20株(35.7%),pap A毒力基因阳性菌株4株(7.1%),未检测到其他毒力基因。omp T毒力基因阳性和阴性菌株均未发现对哌拉西林/他唑巴坦、美洛培南、丁胺卡那霉素、厄他培南、亚胺培南和替加环素存在耐药性。omp T毒力基因阳性菌株对头孢他啶的耐药率高于阴性菌株,差异有统计学意义(P<0.05)。药物治疗后1周,20例omp T毒力基因阳性患者未治愈15例(75.0%),出现复发症状者11例(55.0%);36例omp T毒力基因阴性患者未治愈10例(27.8%),出现复发症状者6例(16.7%)。omp T毒力基因阳性与阴性患者未治愈及复发患者比例比较,差异均有统计学意义(χ~2=11.601、8.936,P<0.05)。结论社区获得性携带omp T毒力基因的UPEC可能与其对头孢他啶的耐药性有关,菌株毒力强,易反复感染。Objective To understand the virulence gene and drug tolerance of community - acquired UPEC and explore the correlation between virulence gene and the prognosis of the disease. Methods We collected 56 strains of community - acquired UPEC from patients with urinary tract infection （UTI） who received treatment in Shaoxing People＇ s Hospital from 2013 to 2014. We conducted drug sensitive test by K-B method and microdilution method. The results of the drug sensitive test were determined according to CLSI 2014 drug sensitive test standard. Virulence genes were detected by using PCR, including papA, cnfl, cnf2, cfaB, ipaB, hofQ and ompT. Analysis of disease development and relapse was performed based on clinical data, Results Among the 56 strains of UPEC, we found 20 （35.7%） ompT - positive strains and 4 （7.1%） papA - positive ,i strains; no other virulence genes were found, ompT - positive strains and ompT - negative strains had no drug resistance to piperacillin/tazobactam, meropenem, amikacin, ertapenem, imipenem and tigecycline, ompT- positive strains had higher drug resistance rate to eeflazidime than ompT - negative strains （ P 〈 0. 05 ）. One - week after medication, 15 （ 75. 0%） patients did not cure and 11 （55.0%） patients had relapse among 20 patients with ompT - positive strains; l0 （27. 8%, ） patients did nut cure and 6 （ 16.7% ） patients had relapse among 36 patients with ompT - negative strains. There were signifieant differences in the rate of not heing cured and relapse between patients with ompT - posilive strains or papA - negalive strains （ X^2 = 11. 601 , 8. 936; P 〈 0. 05 ）. Conclusion Community - acquired UPEC carrying ompT may he related to its resistance to eeftazidime, and the strains have strong virulence, and usually cause repeated infections.

关 键 词：尿路致病性大肠埃希菌 社区获得性感染 毒力 耐药性 

分 类 号：R378.21[医药卫生—病原生物学]