产ESBLs大肠埃希菌毒力因子与尿路感染复发的研究  

Virulence factors related to the recurrence of urinary tract infection of extended-spectrum β-lactamase-producing Escherichia coli

作　　者：王啸波 夏红 文翔 邓敏 杨玉霞 王施刚 贾蓓[1] WANG Xiao-bo;XIA Hong;WEN Xiang;DENG Min;YANG Yu-xia;WANG Shi-gang;JIA Bei(Department of Infectious Diseases,Key Laboratory of Infectious and Parasitic Diseases in Chongqing,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Infectious Diseases,The People’s Hospital of Dazu District,Chongqing 402360,China)

机构地区：[1]重庆医科大学附属第一医院感染科重庆市传染病寄生虫病重点实验室,重庆400016 [2]大足区人民医院感染科,重庆402360

出　　处：《中国感染控制杂志》2023年第7期765-774,共10页Chinese Journal of Infection Control

基　　金：重庆市科卫联合医学科研项目(2019ZDXM042)。

摘　　要：目的 探讨产超广谱β-内酰胺酶尿源性大肠埃希菌(ESBLs-UPEC)毒力因子与尿路感染复发之间的关系。方法 收集2019年1月—2021年9月重庆医科大学附属第一医院和大足区人民医院的尿路感染患者分离的469株ESBLs-UPEC,采用多重RCR扩增技术检测毒力因子,并随访患者6个月内尿路感染复发情况。结果 469株ESBLs-UPEC对替加环素、厄他培南、阿米卡星敏感性较好,对左氧氟沙星、复方磺胺甲口恶唑和氨苄西林高度耐药。尿路感染复发前后ESBLs-UPEC对抗菌药物的敏感率比较,差异无统计学意义(P>0.05)。469株ESBLs-UPEC中90.4%的菌株携带毒力因子fimH,毒力因子sfaDE检出率最低,为8.3%;不同的毒力因子数量、组合方式与尿路感染复发之间无明显的相关性(P>0.05);复发≥3次组患者尿路感染分离的ESBLs-UPEC毒力因子iucD携带率较高(P=0.008);相同性别、年龄阶段复发组和未复发组患者尿路感染分离的ESBLs-UPEC毒力因子携带率比较,差异无统计学意义(P>0.05);绝经后女性患者,复发组ESBLs-UPEC毒力因子kps MT II携带率高于未复发组(61.7%VS 45.6%,P=0.037)。结论 ESBLs-UPEC菌株耐药较严重。ESBLs-UPEC携带最多的毒力因子为fimH,尿路感染复发≥3次患者分离的ESBLs-UPEC毒力因子iucD携带率较高,而绝经后女性复发尿路感染患者分离的ESBLs-UPEC毒力因子kps MT II携带率较高。Objective To explore the relationship between the virulence factors of extended-spectrumβ-lactamases-producing uropathogenic Escherichia coli(ESBLs-UPEC)and recurrence of urinary tract infection(UTI).Methods 469 ESBLs-UPEC strains were obtained from patients with UTI in the First Affiliated Hospital of Chongqing Medical University and the People’s Hospital of Dazu District from January 2019 to September 2021.Multiple PCR amplification was used to identify virulence factors.All patients were followed up for UTI within 6 months.Results 469 ESBLs-UPEC strains were susceptible to tigecycline,ertapenem and amikacin,while showed high resistance to levofloxacin,cotrimoxazole,and ampicillin.There was no statistically significant difference in antimicrobial susceptibility of ESBLs-UPEC before and after UTI recurrence(P>0.05).90.4%of the 469 ESBLs-UPEC strains carried the virulence factor fim H,while the detection rate of sfa DE was the lowest(8.3%).There was no obvious correlation between the number and combination of different virulence factors and UTI recurrence(P>0.05).The carria-ge rate of virulence factor iuc D in ESBLs-UPEC isolated from UTI was higher in patients group with≥3 recurrences(P=0.008).There was no statistically significant difference in the carriage rate of virulence factors in ESBLs-UPEC isolated from recurrent and non-recurrent groups of patients of the same gender and age group(P>0.05).Among postmenopausal female patients,the carriage rate of virulence factor kps MT II in ESBLs-UPEC isolated from recurrent group was higher than that in the non-recurrent group(61.7%vs 45.6%,P=0.037).Conclusion Antimicrobial resistance of ESBLs-UPEC strains is serious.The virulence factor most commonly carried by ESBLs-UPEC is fim H.The carriage rate of virulence factor iuc D in ESBLs-UPEC from patients with≥3 recurrences of UTI is high.The carriage rate of virulence factor kps MT II in ESBLs-UPEC from postmenopausal women with recurrent UTI is high.

关 键 词：大肠埃希菌 产超广谱Β-内酰胺酶 尿路感染 复发 毒力因子 

分 类 号：R515.9[医药卫生—内科学]