2015-2019年上海某院致泻性大肠埃希菌流行与耐药特征  

Epidemic and drug resistance characteristics of Diarrheal Escherichia coil in a hospital of Shanghai from 2015 to 2019

作　　者：施怡茹 郁晞[1] 卢晓芸[1] 马树文 龚羲 徐秋芳[1] SHI Yiru;YU Xi;LU Xiaoyun;MA Shuwen;GONG Xi;XU Qiufang(Department of Microbiology Laboratory,Center for Disease Control and Prevention of Qingpu,Shanghai 201700,China)

机构地区：[1]上海市青浦区疾病预防控制中心微生物检验科,上海201700

出　　处：《检验医学与临床》2023年第10期1358-1363,1368,共7页Laboratory Medicine and Clinic

基　　金：上海市疾病预防控制青年骨干人才培养项目(21QNGG13);上海市青浦区科学技术发展基金项目(QKY2021-30);上海市青浦区科学技术发展基金项目(QKY2020-10)。

摘　　要：目的了解上海市青浦区腹泻病监测定点医院上海复旦大学附属中山医院青浦分院(以下简称该院)2015-2019年腹泻门诊致泻性大肠埃希菌的流行和耐药特征。方法收集该院2015-2019年腹泻门诊患者中经传统细菌学分离鉴定的致泻性大肠埃希菌菌株,使用微量肉汤稀释法测定抗菌药物敏感性,进行耐药性分析。结果2015-2019年该院腹泻门诊患者中致泻性大肠埃希菌的检出率为11.42%(513/4494),主要为肠产毒性大肠埃希菌(66.08%、339株),其次为肠致病性大肠埃希菌(18.91%、97株)和肠集聚性大肠埃希菌(14.42%、74株)。完成500株致泻性大肠埃希菌的药物敏感性试验,耐药以萘啶酸(60.20%)最严重,其次为氨苄西林(57.80%),其他依次为复方磺胺甲噁唑(31.40%)、磺胺异噁唑(30.20%)和四环普林(27.60%)。各毒力分型致泻性大肠埃希菌对不同抗菌药物的耐药性不同,肠产毒性大肠埃希菌对11种抗菌药物的耐药率低于肠致病性大肠埃希菌、肠集聚性大肠埃希菌,差异有统计学意义(P<0.05)。2015-2019年多重耐药(MDR)率为46.40%;不同毒力分型间的MDR率比较,差异有统计学意义(P<0.05);不同职业、户籍患者的MDR率比较,差异有统计学意义(P<0.05)。发现52株产超广谱β-内酰胺酶(ESBLs)菌株,3株对碳青霉烯类抗菌药物耐药菌株。结论青浦区该腹泻病监测定点医院腹泻门诊致泻性大肠埃希菌菌株的耐药情况和MDR情况相对严峻,其耐药与菌株毒力分型、人群职业等有关;同时发现碳青霉烯类抗菌药物耐药株和多株产ESBLs菌株,需引起医疗单位重视并加以防控。Objective To understand the epidemic and drug resistance characteristics of diarrheal Escherichia coli in designated hospital for diarrhoeal disease surveillace Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University of Shanghai from 2015 to 2019.Methods The diarrheal Escherichia coli stranis isolated and identified by traditional bacteriology were collected from diarrhea outpatient cases of the hospital from 2015 to 2019.The antimicrobial susceptibility was determined by microbroth dilution method,and the drug resistance was analyzed.Results From 2015 to 2019,the detection rate of diarrhoeal Escherichia coli was 11.42%(513/4494),mainly Enterotoxic Escherichia coli(66.08%,339 strains),Enteropathogenic Escherichia coli(18.91%,97 strains)and Enteroagglomerative Escherichia coli(14.42%,74 strains)followed.The drug susceptibility test of 500 strains of diarrhoeal Escherichia coli was completed,nalidixic acid(60.20%)was the most severe drug resistance,followed by ampicillin(57.80%),compound sulfamethoxazole(31.40%),sulfamisoxazole(30.20%)and tetracycline(27.60%).The resistance rates of Enterotoxic Escherichia coli to 11 kinds of antibiotics were lower than those of Enteropathogenic Escherichia coli and Enteroagglomerative Escherichia coli,the differences were statistically significant(P<0.05).The multiple drug resistance(MDR)rate from 2015 to 2019 was 46.40%,the differences of MDR rate among different virulence types were statistically significant(P<0.05).The MDR rates of different occupations and household registration were compared,the differences were statistically significant(P<0.05).A total of 52 strains producing ultra-broad spectrumβ-lactamases(ESBLs)were found,and 3 trains were resistant to carbapenems.Conclusion The drug-resistance and multi-drug resistance of this designated hospital for diarrhoeal disease surveillace hospital in Qingpu is severe,and relate to virulence type and occupation.The study discoveres several carbapenem-resistant strains and ESBLs-produced strains,which neede to be paid

关 键 词：致泻性大肠埃希菌 多重耐药 超广谱Β-内酰胺酶 碳青霉烯类抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]