急性腹泻患者致泻性大肠埃希菌流行情况及耐药性分析  

Pathogen monitoring and antimicrobial resistance of diarrheagenic Escherichia coli in patients with acute diarrhea

作　　者：蒋俊丽[1,2] 陈晓[1,3] 叶先飞 王若南[1,3] 陈瑜[1,3] JIANG Junli CHEN Xiao YE Xianfei WANG Ruonan CHEN Yu(Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310003, China)

机构地区：[1]浙江大学医学院附属第一医院检验科,浙江杭州310003 [2]绍兴第二医院检验科,浙江绍兴312000 [3]浙江省临床体外诊断技术研究重点实验室,浙江杭州310003

出　　处：《中国微生态学杂志》2017年第6期689-693,共5页Chinese Journal of Microecology

基　　金：国家"十二五"科技重大专项(2012ZX10004-210)

摘　　要：目的了解致泻性大肠埃希菌(DEC)在急性腹泻患者中的分布及对常用抗菌药物的敏感性,为疾病的防控和治疗提供依据。方法收集2014年1月至2015年12月期间就诊于浙江大学医学院附属第一医院急性腹泻患者粪便标本,采用常规病原菌检验流程对常见肠道致病菌进行分离培养鉴定,分离到的疑似大肠埃希菌采用多重PCR和单重PCR进行鉴定、分型,采用纸片扩散法(K-B法)对各型DEC进行18种常用药物敏感试验。结果从1 019例急性腹泻患者标本中分离到396株病原菌,其中DEC230株,分离率为22.6%,占所有分离菌株的58.1%,居病原菌首位。230株DEC中,ETEC占56.5%,EAEC占30.4%,EPEC占8.7%,STEC占0.4%,混合型DEC占0.9%,未发现EIEC。各型DEC全年均有检出,其中夏季(6~8月)分离率最高,达24.0%,患者主要分布在19~45岁,男女检出率分别为21.8%和23.2%,差异无统计学意义。DEC对氨苄西林的耐药率最高,达49.3%,对头孢唑林、复方新诺明、氨苄西林/舒巴坦的耐药率分别为46.4%、35.7%、30.9%,其余抗菌药物耐药率均低于15.0%,未出现亚胺培南耐药株。207株DEC中,产ESBLs菌株占41.1%,多重耐药菌株占44.9%。结论 DEC是本地区急性腹泻最常见的细菌性病原,是临床肠道感染中不可忽视的病原之一,尤其是同时携带多型别毒力基因菌株及产ESBLs菌株和多重耐药菌。长期持续监测其分布及耐药趋势,对疾病的预防、治疗具有重要意义。Objective To learn the distribution and antimicrobial susceptibility of diarrheagenic Escherichia coli （DEC） isolated from patients with acute diarrhea, and provide evidence for the prevention and treatment. Methods The suspicious strains were isolated from acute diarrhea patients in Hangzhou area from January 2014 to December 2015 by using conventional methods. Multiplex PCR and monoplex PCR were applied to detect 12 virulence genes, and K-B method was used to carry out 18 commonly used drug susceptibility tests for all types of DEC. Results A total of 396 enteric pathogens were isolated from 1019 specimens. DEC was found in 230 cases （22.6%, 230/1019） and accounted for 58.1% of all isolates, ranked 1st among the pathogenic bacteria. Among the 230 DECs, ETEC accounted for 56.5%, EAEC 30.4%, EPEC 8.7%, and STEC 0.4%. Two different pathotypes of DEC strains were isolated from 9 specimens of patients with mixed infections. No EIEC was found. All types of DEC were isolated throughout the year, mainly from June to August. DEC infections occurred mainly in young adults of 18 - 45 years old. There was no significant difference in the detection rate between male （21.8%） and female （23.2%）. Of the 207 isolates, 49.3% were resistant to Ampicillin. The resistance rate to Cefazolin, Trimethoprim/Sulfamethoxazole and Ampicillin/Sulbactam were 46.4%, 35.7% and 30.9% respectively, while those to the rest antibiotics were all less than 15.0%. All the isolates were sensitive to Imipenem. ESBLs-producing strains accounted for 41.1% and multidrug-resistant strains accounted for 44.9%. Conclusion DEC, especially ESBLs-producing strains, multidrug-resistant strains and some pathotypes with multiple virulence genes, were the unneglectable pathogens in intestinal infections, which were the most common pathogens that cause diarrhea in Hangzhou area. Long-term monitoring on epidemic trend and drug resistance is of great significance for disease prevention and treatment.

关 键 词：急性腹泻 致泻性大肠埃希菌 毒力基因 抗菌药物敏感性 

分 类 号：R378.21[医药卫生—病原生物学]