孕晚期阴道大肠埃希菌耐药性及产超广谱β-内酰胺酶菌株耐药基因分析  

Analysis of the drug resistance of vaginal Escherichia coli and the drug resistance genes of producing extended spectyum β-lactamases bacterial strain of pregnant women during the third trimester of pregnancy

作　　者：黄雨茅 金伟敏 郑戈[1] 杨黎明 HUANG Yumao;JIN Weimin;ZHENG Ge;YANG Liming(Ruian People's Hospital,Ruian,Zhejiang Province,325200)

机构地区：[1]浙江省瑞安市人民医院,325200

出　　处：《中国计划生育学杂志》2023年第2期340-346,共7页Chinese Journal of Family Planning

基　　金：温州市科技局基础性医疗卫生科技项目(经费自筹)(Y20210292)。

摘　　要：目的:分析孕晚期孕妇阴道大肠埃希菌耐药性及产超广谱β-内酰胺酶(ESBLs)菌株耐药基因检测。方法:收集2022年1-9月本院产前检查的孕晚期孕妇阴道分泌物标本,检测大肠埃希菌菌株并分析对临床常用抗生素的耐药性以及耐药基因型。结果:获得的298株孕晚期孕妇阴道大肠埃希菌,对碳青霉烯类和β-内酰胺酶抑制剂以及氨基糖苷类(阿米卡星)的敏感率达98.0%~100.0%,对青霉素、头孢菌素、磺胺类和喹诺酮类的耐药性较高,依次为72.8%~38.9%;产ESBLs阳性检出率为47.7%(142/298例),ESBLs阳性菌株对青霉素类、头孢菌素、单酰胺类、氨基糖苷类、喹诺酮类和磺胺类等多种抗生素耐药率高于产ESBLs阴性菌株(P<0.05)。142株(47.7%)产ESBLs大肠埃希菌的耐药基因型分布为CTX-M(81.7%)、TEM-1(59.2%)、SHV(21.1%)和OXA(2.1%)。基因型组合以CTXM-15+TEM-1(21.8%)、CTXM-15+TEM-1(20.4%)和CTXM-15(13.4%)等为主,CTX-M型的产ESBL大肠埃希菌对头孢噻肟(CTX)耐药率高于TEM和SHV型,对头孢他啶(CAZ)的耐药率低于TEM和SHV型(均P<0.05),3种耐药基因型的产ESBL大肠埃希菌对其他抗生素耐药率无差异(P>0.05)。结论:孕晚期阴道大肠埃希菌的产ESBLs菌株耐药基因型以TEM-1、CTX-M-15、CTX-M-14为主,临床应慎用青霉素、头孢菌素、磺胺类和喹诺酮类药物治疗。Objective: To analyze the drug resistance of vaginal Escherichia coli(E. coli), and to detect the drug resistance genes of producing extended spectyum β-lactamases bacterial strain(ESBLs) of pregnant women during the third trimester of pregnancy. Methods: The samples vaginal secretions of the pregnant women during the third trimester of pregnancy were collected to detect the E. coli strains and to analyze the drug resistance of clinical antibiotics used commonly and the drug resistance genotypes from January 2022 to September 2022. Results: 298 strains of vaginal E. coli of the pregnant women during the third trimester of pregnancy had been obtained, which were sensitive to carbapenems, β-lactamase inhibitors, and aminoglycosides(amicacin) was 98.0% to 100.0%, but the higher resistant of which to penicillin, cephalosporin, sulfonamides, and quinolones was 72.8% to 38.9%. The positive detection rate of ESBLs was 47.7%(142/298 cases). The resistance rate of ESBLs-positive strains to penicillin, cephalosporins, monoamides, aminoglycosides, quinolones, sulfonamides, and other antibiotics was significantly higher than that of ESBLs-negative strains(P<0.05). The drug-resistant genotypes of 142 strains(47.7%) EsBLS-producing E. coli were CTX-M(81.7%), TEM-1(59.2%), SHV(21.1%), and OXA(2.1%). The genotype combinations were mainly CTXM-15 and TEM-1(21.8%), CTXM-15 and TEM-1(20.4%), and CTXM-15(13.4%). The resistance rate for cefotaxime(CTX) of producing ESBL of E. coli of CTX-M type was significantly higher in than that of TEM type or SHV type.The resistance rate for ceftazidime(CAZ)of producing ESBL of E.coli of CTX-M type was significantly lower than that of type or SHV type(all P<0.05).There was no significant difference in the resistance rate for other antibiotics of producing ESBL of E.coli among CTX-M type,TEM type,and SHV type(P>0.05).Conclusion:The producing ESBLs strains of vaginal E.coli from the pregnant women during the third trimester of pregnancy are mainly TEM-1,CTX-M-15,and CTX-M-14.The treatments of vag

关 键 词：孕晚期 大肠埃希菌 耐药性 超广谱Β-内酰胺酶 耐药基因 

分 类 号：R711.31[医药卫生—妇产科学] R446.5[医药卫生—临床医学]