2013-2016年广东省腹泻患者致泻性大肠埃希菌病原学监测  

Monitoring of diarrheagenic Escherichia coli infections in patients in Guangdong Province during 2013 to 2016

作　　者：何冬梅[1] 梁宇恒[1] 柯碧霞[1] 曾洪辉 刘美真[1] 谭海玲[1] 李柏生[1] 杨彤 柯昌文[1] He Dongmei;Liang Yuheng;Ke Bixia;Zeng Honghui;Liu Meizhen;Tan Hailing;Li Bo- sheng;Yang Tong;Ke Changwen(Institute of Pathogenic Microorganisms, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China;Drug Resistance Monitoring Laboratory, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou 510440, Chin)

机构地区：[1]广东省疾病预防控制中心病原微生物所,广州511430 [2]广东省生物制品与药物研究所耐药监测室,广州510440

出　　处：《中华微生物学和免疫学杂志》2018年第5期345-353,共9页Chinese Journal of Microbiology and Immunology

基　　金：广东省科技计划项目（20138060400012,2014A020219004）;中美新发和再发传染病合作项目（1U2GGH000018-01）

摘　　要：目的了解广东省腹泻患者致泻性大肠埃希菌（DEC）的感染状况及菌株的血清型分布、药物敏感性和分子特征。方法采集粪便标本进行传统分离培养，对疑似菌株进行多重PCR毒力基因鉴定和生化鉴定，获得阳性菌株进行血清学分型、药物敏感试验和脉冲场凝胶电泳（PFGE）。结果腹泻患者中DEC的总阳性率为6.26%，肠致病性大肠埃希菌（EPEC）、肠产毒性大肠埃希菌（ETEC）、肠出血性大肠埃希菌（EHEC）、肠集聚性大肠埃希菌（EAEC）和肠侵袭性大肠埃希菌（EIEC）的阳性率分别为2.47%、1.54%、1.32%、0.62%和0.09%，以0～〈7岁的儿童感染为主。血清分型率为52.54%，EHEC分子血清分型率为15.00%。DEC对亚胺培南、环丙沙星、头孢他啶和头孢噻肟的敏感率较高。DEC多重耐药率为58.45%，EPEC多重耐药现象最严重。广东省腹泻患者ETEC、EHEC、EPEC和EAEC的PFGE图谱呈现高度多态性。结论EPEC是广东地区DEC流行的优势型别，首选三代头孢菌素为儿童感染治疗用药，成人还可选用环丙沙星。DEC多重耐药现象严重，应加强DEC的病原学监测和耐药性监测。ObjectiveTo investigate the infection status, serotype distribution, drug sensitivity and molecular characteristics of diarrheagenic Escherichia coli （DEC） in patients with diarrhea in Guangdong Province.MethodsFecal samples were collected, cultured and isolated by traditional methods. Suspected Escherichia coli isolates were confirmed by multiplex PCR used for detecting specific virulence genes and biochemical methods. Positive strains were serotyped, characterized for drug sensitivity and analyzed by pulsed-field gel electrophoresis （PFGE）.ResultsThe total positive rate of DEC in patients with diarrhea was 6.26%. The positive rates of enteropathogenic Escherichia coli （EPEC）, enterotoxigenic Escherichia coli （ETEC）, enterohemorrhagic Escherichia coli （EHEC）, enteroadherent Escherichia coli （EAEC） and enteroinvasive Escherichia coli （EIEC） were 2.47%, 1.54%, 1.32%, 0.62% and 0.09%, respectively, with infections primarily in children aged 0-〈7 years. The total seropositive rate was 52.54%, with EHEC accounting for 15.00%. DEC showed high sensitivity to imipenem, ciprofloxacin, ceftazidime and cefotaxime. The multidrug resistance rate of DEC was 58.45%, with EPEC being the most serious for multidrug resistance. PFGE results showed that ETEC, EHEC, EPEC and EAEC had a high degree of polymorphism.ConclusionEPEC is the predominant type of DEC circulating in Guangdong Province. Third-generation cephalosporins are the first drugs of choice for treating infections in children. Ciprofloxacin can be used to treat adults. The problem of multiple drug resistance of DEC is severe and efforts to monitor DEC infections and drug resistance should be strengthened.

关 键 词：致泻性大肠埃希菌 毒力基因 病原学监测 细菌耐药性监测 脉冲场凝胶电泳 

分 类 号：R446.5[医药卫生—诊断学]