上海市奉贤区2019-2022年产超广谱β-内酰胺酶致泻性大肠埃希菌耐药性和同源性分析  

Analysis of the drug resistance and homology ofβ-lactamase-producing diarrheagenic Escherichia coli in Fengxian District of Shanghai from 2019 to 2022

作　　者：赵宏伟 谢晓红[1] 胡屹[2] 庄源[3] 陶力新 刘梅花 沈莉[1] 沈春莉[1] 施媛 盛黄妃 ZHAO Hongwei;XIE Xiaohong;HU Yi;ZHUANG Yuan;TAO Lixin;LIU Meihua;SHEN Li;SHEN Chunli;SHI Yuan;SHENG Huangfei(Department of Microbiology,Fengxian District Center for Disease Prevention and Control,Shanghai 201499,China;Department of Epidemiology and Biostatistics,School of Public Health,Fudan University,Shanghai 200032,China;Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市奉贤区疾病预防控制中心微生物检验科,上海201499 [2]复旦大学公共卫生学院,上海200032 [3]上海市疾病预防控制中心,上海200336

出　　处：《中国热带医学》2024年第11期1370-1375,1389,共7页China Tropical Medicine

基　　金：上海市加强公共卫生体系建设三年行动计划(2023—2025年)(上海市卫建委GWⅥ-3);上海市卫计委项目(No.20184Y0259)。

摘　　要：目的开展上海市奉贤区产超广谱β-内酰胺酶(extended-spectrumβ-lactamases,ESBLs)致泻性大肠埃希菌(diarrheagenic E.coli,DEC)耐药性和同源性分析,为临床合理用药和风险监测预警提供依据。方法收集2019—2022年上海市奉贤区腹泻病检测中分离到的致泻性大肠埃希菌,采用微量肉汤稀释法进行21种药物敏感试验,用脉冲场凝胶电泳技术进行聚类分型。结果690例腹泻病例DEC检出率为18.99%、ESBLs-DEC检出率为5.22%,肠毒性大肠埃希杆菌在15~<60岁的青壮年中检出率最高(6.20%)。36株ESBLs-DEC对头孢他啶、亚胺培南、美罗培南和阿米卡星全部敏感,对头孢唑啉、头孢噻肟和多黏菌素E全部耐药。其他耐药性较高的有氨苄西林(91.67%)、四环素(44.44%)、复方新诺明(44.44%)。ESBLs-DEC对头孢唑啉、头孢吡肟和氨苄西林的耐药率高于非ESBLs-DEC。2019—2022年ESBLs-DEC对左氧氟沙星耐药率由0升高到40%,对四环素耐药率从22.22%升高到44.44%。ESBLs-DEC全部为多重耐药,共产生22种耐药谱。36株ESBLs-DEC经PFGE聚类分析相似度为47.8%~97.1%,得到34种带型,带型分散呈现多态性。结论上海市奉贤区腹泻病例中ESBLs-DEC流行强度不高但耐药形势严峻,引导临床和农业对抗生素的合理使用是控制耐药升高的关键环节。Objective To investigate the drug resistance and homology analysis ofβ-lactamase-producing diarrheagenic Escherichia coli(ESBLs-DEC)in Fengxian District,Shanghai,to provide a reference for clinical rational use of medication and risk monitoring and early warning.Methods Diarrhea-causing Escherichia coli isolated from diarrhea patients in Fengxian District,Shanghai,from 2019 to 2022 were collected.Minimum inhibitory concentration(MIC)based on microbroth dilution method was used to conduct 21 drug resistance experiments,and genotyping detection and homology analysis were conducted with pulsed-field gel electrophoresis(PFGE).Results The DEC detection rate in 690 diarrhea cases was 18.99%,ESBLs-DEC was 5.22%,and ETEC was highest among young adults aged 15-<60 years(6.20%).All 36 ESBLs-DEC strains were sensitive to ceftazidime,imipenem,meropenem,and amikacin;they were all resistant to cefazoline,cefotaxime,and polymyxin E.Other drugs with high resistance rates included ampicillin(91.67%),tetracycline(44.44%),and cotrimoxazole(44.44%).ESBLs-DEC showed higher cefazolin,cefepime,and ampicillin resistance than non-ESBLs-DEC.From 2019 to 2022,the resistance rate of ESBLs-DEC to levofloxacin increased from 0%to 40%,and the resistance rate to tetracycline increased from 22.22%to 44.44%.All strains of ESBLs-DEC were multidrug-resistant,yielding a total of 22 drug resistance profiles.The PFGE clustering analysis of the 36 strains of ESBLs-DEC showed a similarity range of 47.8%to 97.1%,resulting in 34 band patterns,with band-type dispersion presenting polymorphism.Conclusions Although the prevalence of ESBLs-DEC in diarrhea cases in Fengxian District of Shanghai is not high,the drug resistance situation is severe.Guiding the rational use of antibiotics in clinical and agriculture is crucial in controlling the increase of drug resistance.

关 键 词：Β-内酰胺酶 致泻性大肠埃希菌 耐药 脉冲场凝胶电泳 

分 类 号：R446.5[医药卫生—诊断学]