多重耐药大肠埃希菌流行病学特征及耐药机制研究  

Epidemiological characteristics and drug resistance mechanism of multidrug-resistant Escherichia coli

作　　者：钟明琳 李荔[2] 张文婕 晏嘉 陈旋 温伟洪[3] 徐令清[3] ZHONG Minlin;LI Li;ZHANG Wenjie;YAN Jia;CHEN Xuan;WEN Weihong;XU Lingqing(Guangzhou Medical University,Guangzhou,Guangdong 511495,China;Department of Obstetrics and Gynecology,Guangdong Women and Children Hospital,Guangzhou,Guangdong 511442,China;the Sixth Affiliated Hospital of Guangzhou Medical University/Qingyuan People′s Hospital,Qingyuan,Guangdong 511518,China)

机构地区：[1]广州医科大学,广东广州511442 [2]广东省妇幼保健院妇产科,广东广州511442 [3]广州医科大学附属第六医院/清远市人民医院检验科,广东清远500518

出　　处：《国际检验医学杂志》2023年第S02期15-21,共7页International Journal of Laboratory Medicine

基　　金：广东省中医药局项目(20201407);广东省科技创新战略专项资金(DZXQY002);广东省医学科学技术研究基金(A2021490);清远市人民医院医学科研基金支持项目(202301-201);清远市科技计划项目(200808114560452)。

摘　　要：目的比较临床分离的耐碳青霉烯类大肠埃希菌(CRECO)、产ESBL大肠埃希菌(ESBL-ECO)以及非产ESBL大肠埃希菌(non-ESBL-ECO)的耐药特征及流行病学特征。方法收集2018-2022清远市人民医院(下称该院)临床分离的CRECO、ESBL-ECO、非产ESBLECO菌株各20株,用BD Phoenix-M50全自动细菌鉴定/药敏系统进行菌株鉴定和体外药敏试验,通过聚合酶链反应试验(PCR)检测碳青霉烯酶、ESBL酶、AmpC酶和膜孔蛋白等13种相关耐药基因,菌株间同源性采用ERIC-PCR进行分析。结果60株大肠埃希菌中,携带率较高的基因有blaGES 44株(73.3%),blaTEM 37株(61.7%),blaDHA 31株(51.7%),携带率较低的基因有blaIMP 10株(16.7%),blaNDM 3株(5.0%),blaSHV 2株(3.3%)。其中CRECO组主要携带blaGES(75.0%),其次为blaTEM(70.0%),blaKPC(60.0%),ESBL-ECO组主要携带blaGES(85.0%),其次为blaTEM(70.0%);非ESBL-ECO组主要携带blaG ES(60.0%)和blaDHA(60.0%),其次为blaVIM(55.0%)。膜孔蛋白基因中OMPF、OMPC缺失/突变率分别为38.3%、1.7%,OMPK35、OMPK36缺失/突变率分别为5.0%、100.0%;其中CRECO组5株OMPF缺失或突变(25.0%);ESBL-ECO组3株OMPF缺失或突变(15.0%);非产ESBLECO组3株OMPF缺失或突变(15.0%)。ERIC-PCR显示,CRECO组主要为B型5株(25.0%),F型3株(15.0%),ESBL-ECO组主要为A型(30.0%)、B型(20.0%)和E型(20.0%);非ESBL-ECO组主要为A型(35.0%)和C型(30.0%)。药敏结果分析发现,在20株CRECO中,仅对阿米卡星和氨曲南耐药率较低(25.0%~35.0%);在20株ESBL阳性菌中,对青霉素类和除头孢他啶外头孢霉素抗菌药物耐药率高;在20株非产ESBL的大肠埃希菌中,对四环素耐药率最高(65.0%)。结论该院ECO主要携带blaGES、blaTEM、blaDHA;CRECO组多携带blaKPC,菌株间水平传播现象较严重,耐药菌携带多种耐药基因情况多见,且均合并一种或两种膜孔蛋白基因突变或缺失,可见CRECO耐药机制与携带多种耐药基因并膜孔蛋白缺失或突变有关。ESBL-ECO组携带blaTEM多见,且存在同时�Objective To compare the drug resistance characteristics and homology among clinical isolates of Carbapenem-resistant Escherichia coli(CRECO),ESBL-producing Escherichia coli(ESBL-ECO)and non-ESBL-producing Escherichia coli.Methods A total of 20 clinical isolates of CRECO,20 ESBL-ECO and 20 non-ESBL-producing strains were collected from 2018 to 2022 in our hospital.The full-automatic bacterial identification/drug sensitivity system of BD Phoenix-M50 was used for strain identification and in vitro drug sensitivity test.A total of 13 related resistance genes including carbapenemase,ESBL enzyme,AmpC enzyme and membrane pore were detected by polymerase chain reaction(PCR).The homology between the strains was compared and analyzed by ERIC-PCR.Results Among the 60 E.coli strains,44(73.3%)of blaGES,37(61.7%)of blaTEM37 and 31(51.7%)of blaDHA31 were found to have high gene carrying rate,while 10(16.7%)of blaIMP,3(5%)of blaNDM and 3.3%of blaSHV were found to have low gene carrying rate,blaGES was mainly carried by CRECO group(75%),followed by blaTEM(70%)and blaKPC(60%),blaGES was mainly carried in the ESBL-ECO group(85%),followed by blaTEM(70%).The non-ESBL-producing-ECO group predominantly carried blaGES(60%)and blaDHA(60%)followed by blaVIM(55%).The deletion/mutation rates of OMPF and OMPC in the membrane pore protein gene were 38.3%and 1.7%,respectively,and the deletion/mutation rates of OMPK35 and OMPK36 were 5%and 100%,respectively.Five strains of OMPF in CRECO group were missing or mutated(25%);Three strains of OMPF in the ESBL-ECO group were missing or mutated(15%);Three strains of OMPF were missing or mutated(15%)in non-ESBL-producing-ECO group.ERIC-PCR assay showed that in the CRECO group,five strains(25%)were type B,and three strains(15%)were type F.;Type A(30%),B(20%)and E(20%)were the main types in the ESBL-ECO group.Type A(35%)and Type C(30%)were predominant in non-ESBL-producing-ECO group.The analysis of drug sensitivity results showed that among the 20 CRECO strains,the resistance rate to amikacin and aztreo

关 键 词：碳青霉烯类耐药大肠埃希菌 ESBL 膜孔蛋白 同源性 

分 类 号：R446.5[医药卫生—诊断学] R181.3[医药卫生—临床医学]