2013-2019年北京市顺义区腹泻病例分离致泻性大肠埃希菌耐药特征分析  

Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing,2013-2019

作　　者：王园园[1,2] 林帆 王苗[1,2] 康颖 李颖[1,2] 马红梅[1,2] Wang Yuanyuan;Lin Fan;Wang Miao;Kang Ying;Li Ying;Ma Hongmei(Shunyi District Center for Disease,Beijing 101300,China;Workstation for Microbial Infectious Disease,Shunyi District Center for Disease Control and Prevention,Beijing 101300,China;Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]北京市顺义区疾病预防控制中心,北京101300 [2]北京市顺义区疾病预防控制中心微生物感染性疾病检测工作站,北京101300 [3]河北北方学院,河北张家口075000

出　　处：《疾病监测》2021年第12期1324-1330,共7页Disease Surveillance

摘　　要：目的对2013—2019年北京市顺义区2家哨点腹泻病例分离的致泻性大肠埃希菌(DEC)进行耐药特征分析。方法收集2013—2019年北京市顺义区2家哨点医院腹泻病例粪便标本,进行DEC分离培养、生化鉴定与分型鉴定,抗菌药敏感性试验使用微量肉汤法,耐药特征分析包括耐药率、非敏感率、多重耐药率和耐药谱分析。结果腹泻病例DEC检出率为9.53%(232/2434)、肠产毒性大肠埃希菌(ETEC)占56.47%(131/232)、肠致病性大肠埃希菌(EPEC)占27.16%(63/232)、肠聚集性大肠埃希菌(EAEC)占16.38%(38/232)。DEC多重耐药率为33.19%(77/232),共有90种耐药谱型;ETEC多重耐药率为17.56%(23/131),共有36种耐药谱型;EPEC多重耐药率为58.73%(37/63),共有42种耐药谱型;EAEC多重耐药率为44.74%(17/38),共有23种耐药谱型。耐药率≥30%的抗菌药ETEC有萘啶酸(NAL)、氨苄西林(AMP),EPEC有AMP、四环素(TET)、复方新诺明(SXT)、磺胺异恶唑(Sul)、NAL,EAEC有NAL、AMP、SXT、Sul、TET。2013—2016年与2017—2019年两个时间组试验抗菌药差异性比较发现:ETEC对AMP、头孢唑啉(CFZ)、TET、头孢吡肟(FEP)、氨曲南(AZM)、氨苄西林/舒巴坦(AMS)耐药水平上升,对Sul耐药水平下降;EPEC对庆大霉素(GEN)耐药水平下降;EAEC对头孢噻肟(CTX)、GEN、多西环素(DOX)耐药水平下降。结论北京市顺义区腹泻病例中,DEC具有较高的流行强度,ETEC、EPEC和EAEC的流行与耐药均具有较为独立的特征,耐药形势依然严峻;值得应引起公共卫生和临床部门的广泛关注。Objective To study the drug resistance characteristics of Diarrheagenic Escherichia coli(DEC)isolated from patients with diarrhea in two sentinel hospitals in Shunyi district of Beijing during 2013-2019.Methods Stool samples of diarrhea patients were collected in the two sentinel hospitals during this period.Isolation,bacterial identification and PCR typing were conducted for DEC strains.Antimicrobial susceptibility tests were carried out using micro broth method to analyze the drug resistance characteristics of the isolated strains,including resistance rate,non-sensitive rate,multi-drug resistance rate and drug resistance spectrum.Results The detection rate of DEC in diarrhea patients was 9.53%(232/2434).The proportions of Enterotoxic Escherichia coli(ETEC),Enteropathogenic Escherichia coli(EPEC),and Enteroaggregative Escherichia coli(EAEC)were 56.47%(131/232),27.16%(63/232)and 16.38%(38/232),respectively.The multi-drug resistance rates of DEC with 90 drug resistance spectrum,ETEC with 36 drug resistance spectrum,EPEC with 42 drug resistance spectrum,and EAEC with 23 drug resistance spectrum were 33.19%(77/232),17.56%(23/131),58.73%(37/63),44.74%(17/38),respectively.Antibacterial drugs with resistance rate≥30%included nudicacid(NAL)and ampicillin(AMP)for ETEC;AMP,tetracycline(TET),sulfamethoxazole tablets(SXT),sulfamethoxazole(Sul),NAL for EPEC;NAL,AMP,SXT,Sul,TET for EAEC.A comparison of the differences in the antimicrobial susceptibility tests during 2013-2016 and during 2017-2019 found that the resistance of ETEC to AMP,cefazolin(CFZ),TET,cefepime(FEP),aztreonam(AZM),and ampicillin/sulbactam(AMS)increased,while the resistance to Sul decreased;the resistance of EPEC to gentamicin(GEN)decreased;the resistance of EAEC to cefotaxime(CTX),GEN,and doxycycline(DOX)decreased.Conclusion Among the diarrhea cases in Shunyi,theintensity of DEC spread was high,and the spread and the drug resistances of ETEC,EPEC and EAEC had unique characteristics.The drug resistance was serious,to which close attention should be paid.

关 键 词：致泻性大肠埃希菌 腹泻 耐药率 多重耐药率 耐药谱 

分 类 号：R211[医药卫生—中医学] R378.21