崇明岛大肠杆菌所致社区获得性尿路感染患者特点及产ESBLs菌株的基因型和耐药性特点  

Features of patients with community-acquired urinary tract infection caused by Escherichia coli,and genotype and drug resistance features of ESBLs-producing strains in Chongming Island

作　　者：钱敏健 李星军 陆秀英 曹萍 秦云 张莉 QIAN Min-jian;LI Xing-jun;LU Xiu-ying;CAO Ping;QIN Yun;ZHANG Li(Department of Clinical Laboratory,Chongming Branch Hospital,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 202150,China;Department of Clinical Laboratory,Chongming Branch Hospital,Shanghai Tenth People′s Hospital Affiliated to Tongji University,Shanghai 202157,China;Department of Clinical Laboratory,Chongming Branch Hospital,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 202153,China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院检验科,上海市202150 [2]同济大学附属上海市第十人民医院崇明分院检验科,上海市202157 [3]上海中医药大学附属岳阳中西医结合医院崇明分院检验科,上海市202153

出　　处：《广西医学》2019年第23期3026-3032,共7页Guangxi Medical Journal

基　　金：上海市崇明区“可持续发展科技创新行动计划”项目(CKY2017-08)

摘　　要：目的分析调查崇明岛大肠杆菌所致获得性尿路感染(CA-UTI)患者特点,以及产超广谱β-内酰胺酶(ESBLs)菌株的耐药性及基因型。方法收集272株分离自崇明岛CA-UTI患者的大肠杆菌,检测其耐药性及表型。采用PCR检测产ESBLs大肠杆菌的基因型,并对PCR产物进行核苷酸序列分析,以确定耐药基因类型。结果(1)崇明岛大肠杆菌所致CA-UTI患者主要集中在城桥镇(13.2%)、堡镇(10.7%)和陈家镇(9.9%)等地;共检出147株产ESBLs大肠杆菌,病例主要来自城桥镇、堡镇、陈家镇和庙镇。(2)大肠杆菌所致CA-UTI患者以女性为主,主要为41~<90岁人群;女性患者产ESBLs大肠杆菌的检出率高于男性,但差异无统计学意义(P>0.05)。(3)产ESBLs大肠杆菌对亚胺培南和美罗培南的耐药率均为0,对头孢噻肟、头孢呋辛和头孢唑林耐药率均为100%,对环丙沙星和复方磺胺甲恶唑的耐药率均高于50%。非产ESBLs大肠杆菌对亚胺培南和美罗培南的耐药率均为0,对环丙沙星的耐药率最高(56.0%),其次为复方磺胺甲恶唑和头孢唑林。(4)147株产ESBLs大肠杆菌中,123株获得基因分型,包括CTX-M型菌株115株,SHV型菌株12株,TEM型菌株96株。CTX-M型菌株耐药基因的序列为CTX-M-14(52/115)和CTX-M-15(63/115),TEM型菌株耐药基因的序列均为TEM-1。(5)3种基因型产ESBLs大肠杆菌对头孢噻肟、头孢呋辛和头孢唑林等头孢菌素类抗菌药物的耐药率均为100.0%。结论崇明岛大肠杆菌所致CA-UTI患者主要分布于城桥镇、堡镇和陈家镇,女性患者为主;CTX-M-14、CTX-M-15、TEM-1型是该地区引起CA-UTI的ESBLs大肠杆菌的主要基因型;不建议使用氟喹诺酮类和磺胺类抗菌药物作为临床治疗该地区大肠杆菌所致CA-UTI的经验用药,以控制多重耐药株的产生。Objective To analyze the characteristics of the patients with community-acquired urinary tract infection(CA-UTI)caused by Escherichia coli,as well as the drug resistance and genotype of extended-spectrumβ-lactamases(ESBLs)-producing strains in Chongming Island.Methods Totally 272 strains of Escherichia coli isolated from the CA-UTI patients in Chongming Island were collected,and then the drug resistance and phenotype were detected.PCR was employed to determine the genotype of ESBLs-producing Escherichia coli,and nucleotide sequence analysis was conducted on PCR products to confirm the type of resistance genes.Results(1)In Chongming Island,the patients with Escherichia coli-induced CA-UTI were mainly distributed in Chengqiao Town(13.2%),Bao Town(10.7%),and Chenjia Town(9.9%);totally 147 strains of ESBLs-producing Escherichia coli were detected,and these cases were mainly from Chengqiao Town,Bao Town,Chenjia Town,and Miao Town.(2)The patients with Escherichia coli-induced CA-UTI were mainly consisted of females,and were mostly in the 41-<90 age group;the detection rate of ESBLs-producing Escherichia coli was higher in the female patients than that in the male patients,but no statistically significant difference was found(P>0.05).(3)ESBLs-producing Escherichia coli achieved a drug resistance rate of 0 to imipenem or meropenem,but a drug resistance rate of 100%to cefotaxime,cefuroxime or cefazolin,and a drug resistance rate higher than 50%to ciprofloxacin or compound sulfamethoxazole.Non-ESBLs-producing Escherichia coli achieved a drug resistance rate of 0 to imipenem and meropenem,and exhibited the highest drug resistance rate to ciprofloxacin(56.0%)followed by compound sulfamethoxazole and cefazolin.(4)In the 147 strains of ESBLs-producing Escherichia coli,genotypes of 123 strains were obtained,including 115 strains with CTX-M type,12 strains with SHV type and 96 strains with TEM type.The gene sequence was determined as CTX-M-14(52/115)or CTX-M-15(63/115)in the strains with CTX-M type,as TEM-1 in all the strains w

关 键 词：社区获得性尿路感染 大肠杆菌 超广谱Β-内酰胺酶 基因型 耐药性 崇明岛 

分 类 号：R378.2[医药卫生—病原生物学]