妇科住院患者尿路感染病原菌耐药性分析及产ESBLs大肠埃希菌基因分型研究  

The drug resistance analysis of pathogens causing urinary tract infection in gynecological inpatients and genotyping of ESBLs producing Escherichia coli

作　　者：彭怡倩[1] 高晶[1] 陈艺升[1] 陆子贇 应春妹[1] Peng Yiqian

机构地区：[1]复旦大学附属妇产科医院,200011

出　　处：《浙江临床医学》2020年第12期1714-1716,1719,共4页Zhejiang Clinical Medical Journal

摘　　要：目的分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌基因分型及其与妇科疾病和院内感染控制的相关性。方法收集2018年妇科住院患者临床疑为尿路感染患者883份清洁中段尿液标本,培养检出病原菌321株并进行细菌鉴定和药敏结果分析,PCR方法检测产ESBLS大肠埃希菌三种主要耐药基因型并分析其耐药性。结果中段尿培养检出的病原菌中有革兰阴性杆菌82.6%(265/321),革兰阳性球菌15.6%(50/321),真菌1.8%(6/321);产ESBLs大肠埃希菌和非产ESBLs大肠埃希菌对多数抗菌药物的耐药性有显著差异(P<0.05);产ESBLs大肠埃希菌携带主要的三种耐药基因中CTX型和OXA型分布在不同楼层检出率有显著差异(P<0.05)。结论妇科尿路感染患者尿液标本培养检测出的病原菌以大肠埃希菌为主,产ESBLs大肠埃希菌耐药基因型以CTX型、TEM型和OXA型为主,不同的基因型耐药性也有差异,其中CTX型和OXA型的分布在同一建筑楼层病房有水平传播并暴发流行的风险。随着抗菌药物在妇科领城的广泛使用,细菌耐药性逐年提高,研究病原菌流行病学特征和耐药基因分型,为临床合理使用抗菌药物及院内感染的管理控制提供参考。Objective To analyze the genotyping of Escherichia coli with broad-spectrum beta-lactamases(ESBLs)and their association with gynecological diseases and nosocomial infection control.Methods 883 clean mid stage urine samples of hospitalized gynecological patients suspected of urinary tract infection were collected in our hospital in 2018,321 pathogenic bacteria were cultured and detected and bacterial identification and drug sensitivity analysis were performed.PCR method was used to detect three major drug resistance genotypes of Escherichia coli producing ESBLs and their drug resistance analyzed.Results Gram-negative bacili(265/321,82.6%),Gram-positive cocci(50/321,15.6%)and fungi(6/321,1.8%)were detected in mid-course urine culture.ESBLs resistance of Escherichia coli and non-producing ESBLS Escherichia coli to most antimicrobial agents was significantly different(P<0.05);the distribution of CTX and OXA types among the three main resistance genes was significantly different in different floors(P<0.05).Conclusion The main pathogens detected in urine specimen culture of patients with gynecological urinary tract infection are Escherichia coli,ESBLs Escherichia coli drug resistance genotypes are CTX,TEM and OXA,and different genotype drug resistance are also different.With the extensive use of antimicrobial agents in the field of gynecology,bacterial drug resistance has increased year by year,and the epidemiological characteristics and drug resistance genotyping of pathogenic bacteria have been studied,which provides a reference for the management and control of clinical rational use of antimicrobial agents and nosocomial infections.

关 键 词：耐药性 大肠埃希菌 超广谱Β-内酰胺酶 基因型 

分 类 号：R44[医药卫生—诊断学]