急性腹泻患者致泻性大肠埃希菌毒力基因及耐药性分析  

Virulence gene monitoring and antibiotic resistance surveillance of diarrheagenic Escherichia coli among patients with acute diarrhea

作　　者：林菲菲[1] 金晶[1] 吴伟平[1] 陈佳琦[1] LIN Fei-fei;JIN Jing;WU Wei-ping;CHEN Jia-qi(Clinical Laboratory,People's Hospital of Lishui,Lishui,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院检验科,浙江丽水323000

出　　处：《中国卫生检验杂志》2021年第6期684-686,691,共4页Chinese Journal of Health Laboratory Technology

基　　金：浙江省医学会临床科研基金(2019ZYC-A70)。

摘　　要：目的了解急性腹泻患者致泻性大肠埃希菌(DEC)的感染状况、病原学特征及耐药性分析。方法收集2018年7月-2019年12月在本院门急诊就诊的急性腹泻患者粪便标本695例,对常见致病菌进行分离培养鉴定,分离到的疑似大肠埃希菌采用飞行质谱仪和荧光定量PCR进行鉴定和毒力基因分型,对所有DEC进行常规药敏试验。结果在695例腹泻患者中,共分离到DEC 175例,检出率为25.18%。其中肠聚集性大肠埃希菌(EAEC) 107株,占61.14%,肠致病性大肠埃希菌(EPEC) 23株,占13.14%,肠产毒性大肠埃希菌(ETEC) 8株,占4.58%,肠出血性大肠埃希菌(EHEC) 2株,占1.14%,混合型DEC 35株,占20.00%,未检出肠侵袭性大肠埃希菌(EIEC)。DEC对氨苄西林的耐药率最高,为78.29%,对氨苄西林/舒巴坦、复方新诺明、环丙沙星、庆大霉素的耐药率分别为54.86%、45.14%、45.14%、30.86%,其余抗菌药物耐药率均低于30.00%,175株DEC中,产ESBLs菌株占21.71%。结论 DEC是急性腹泻患者的重要病原体之一,EAEC是本地区的主要流行菌型,应继续加强对DEC的流行病学调查及耐药性监测。Objective To understand the infection status,etiological characteristics and antibiotic resistance surveillance of diarrheagenic Escherichia coli( DEC) among patients with acute diarrhea. Methods Totally 695 stool samples were collected from patients with acute diarrhea who were treated in emergency department of our hospital from July 2018 to December 2019.After isolated culturing and identifying the common intestinal pathogenic bacteria,the suspicious Escherichia coli was identified and virulence genotyped by flying mass spectrometry and fluorescent quantitative PCR and all types of DEC were conducted for drug sensitivity test. Results Among 695 diarrhea cases,175 cases of DEC were isolated with a detection rate of 25. 18%,of which 107 enteroadherent Escherichia coli( EAEC),accounting for 61. 14%,followed by 23 strains of enteropathogenic Escherichia coli( EPEC),accounting for 13. 14%,8 strains of enterotoxic Escherichia coli( ETEC),accounting for 4. 58%,2 strains of enterhemorrhagic Escherichia coli( EHEC),accounting for 1. 14%,and 35 strains of mixed DEC,accounting for20. 00%,but no entroinvasive Escherichia coli( EIEC) was detected. DEC had the highest resistance rate to ampicillin( 78. 29%),and it was resistance to ampicillin/sulbactam,selectrin,ciprofloxacin and gentamicin. The resistance rates of them were 54. 86%,45. 14%,45. 14%,30. 86% and the resistance rates of the remaining antimicrobial were less than30. 00%. Among 175 DECs,what could produce ESBLs accounted for 21. 71%. Conclusion DEC was an important pathogen in patients with acute diarrhea,EAEC was a major epidemic and DEC resistance was more serious. Epidemiological investigation and monitoring of drug resistance to the DEC should be continue strengthened.

关 键 词：急性腹泻 致泻性大肠埃希菌 毒力基因 耐药性监测 

分 类 号：R446.1[医药卫生—诊断学]