摘要
目的了解泌尿系感染中大肠埃希菌的耐药情况,以及产ESBLs大肠埃希菌携带β-内酰胺酶基因类型,为泌尿系感染大肠埃希菌防治提供依据。方法收集2017年1月-2018年6月大肠埃希菌致泌尿系感染病例。采用K-B纸片法筛选和确认产ESBLs大肠埃希菌,并测定大肠埃希菌对临床常见14种抗生素耐药情况。采用碱裂解法提取大肠埃希菌DNA,并通过PCR检测产ESBLs株β-内酰胺酶基因类型。结果共分离出197株大肠埃希菌,其中产ESBLs大肠埃希菌116株,占58.88%。产ESBLs大肠埃希菌对头孢呋辛、头孢他啶、头孢曲松、头孢西丁、庆大霉素、妥布霉素、阿米卡星、诺氟沙星、环丙沙星、美罗培南、哌拉西林、氨苄西林/舒巴坦、阿莫西林/克拉维酸、哌拉西林/他唑巴坦等抗生素耐药情况为14种抗生素耐药情况为:116株(100.00%)、116株(100.00%)、116株(100.00%)、22株(18.97%)、72株(62.07%)、61株(52.59%)、15株(12.93%)、69株(59.48%)、57株(49.14%)、1株(0.86%)、116株(100.00%)、81株(69.83%)、19株(16.38%)和8株(6.90%)。非产ESBLs大肠埃希菌耐药情况为:6株(7.41%)、0株(0.00%)、3株(3.70%)、4株(4.94%)、31株(38.27%)、27株(33.33%)、0(0%)、35株(43.21%)、27株(33.33%)、0(0%)、43株(53.09%)、22株(27.16%)、4株(4.94%)和3株(3.70%)。116株大肠埃希菌中β-内酰胺酶基因携带blaTEM、blaSHV、blaOXA-1、blaOXA-2、blaOXA-10、blaCTX-M-1、blaCTX-M-2、blaCTX-M-8和blaCTX-M-9组基因情况分别为:21株(18.10%),6株(5.17%),9株(7.76%),3株(2.59%),0株(0%),61株(52.59%),2株(1.72%),2株(1.72%)和89株(76.72%)。其中单一基因型65株,占56.03%;31株检测到2种基因,占26.72%;14株同时检测到3种基因,占12.07%;6株同时检测到3种以上基因,占5.17%。讨论四川泸州地区产ESBLs大肠埃希菌中blaCTX-M是主要流行型别。他唑巴坦能够有效的抑制β-内酰胺酶,能够使哌拉西林更好发挥其抗菌活性。
Objective To ascertain the drug resistance of Escherichia coli causing a urinary tract infection and the type of beta-lactamase genes carried by ESBL-producing E. coli in order to provide evidence for the prevention and treatment of urinary tract infections caused by E. coli. Methods Subjects were patients with a urinary tract infection caused by E. coli from January 2017 to June 2018. ESBL-producing E. coli was screened and confirmed, and the resistance of E. coli to 14 antibiotics was determined using the K-B disc method. DNA of E. coli was extracted using alkali lysis, and the type of beta-lactamase genes of ESBL-producing strains was detected using PCR. Results One hundred and ninety-seven strains of E. coli were isolated, 116(58.88%) of which produced ESBLs. The resistance of ESBL-producing E. coli to cefuroxime was 100.00%(116 strains), its resistance to ceftazidime was 100.00%(116 strains), its resistance to ceftriaxone was 100.00%(116 strains), its resistance to cefoxitin was 18.97%(22 strains), its resistance to gentamicin was 62.07%(72 strains), its resistance to tobramycin was 52.59%(61 strains), its resistance to amikacin was 12.93%(15 strains), its resistance to norfloxacin was 59.48%(69 strains), its resistance to ciprofloxacin was 49.14%(57 strains), its resistance to meropenem was 0.86%(1 strain), its resistance to piperacillin was 100.00%(116 strains), its resistance to ampicillin/sulbactam was 69.83%(81 strains), its resistance to amoxicillin/clavulanic acid was 16.38%(19 strains), and its resistance to piperacillin/tazobactam was 6.90%(8 strains). The resistance of non-ESBL-producing E. coli to cefuroxime was 7.41%(6 strains), its resistance to ceftazidime was 0.00%(0 strains), its resistance to ceftriaxone 3.70%(3 strains), its resistance to cefoxitin was 4.94%(4 strains), its resistance to gentamicin was 38.27%(31 strains), its resistance to tobramycin was 33.33%(27 strains), its resistance to amikacin was 0%(0 strains), its resistance to norfloxacin was 43.21%(35 strains), its resistance to ciprofloxacin was 33.33%(27 strains), its resistance to meropenem was 0%(0 strains), its resistance to piperacillin was 53.09%(43 strains), its resistance to ampicillin/sulbactam was 27.16%(22 strains), its resistance to amoxicillin/clavulanic acid was 4.94%(4 strains), and its resistance to piperacillin/tazobactam was 3.70%(3 strains). In 116 strains of E. coli, the beta-lactamase gene blaTEM was carried by 21 strains(18.10%), blaSHV was carried by 6 strains(5.17%), blaOXA-1 was carried by 9 strains(7.76%), blaOXA-2 was carried by 3 strains(2.59%), blaOXA-10 was carried by 0 strains(0%), blaCTX-M-1 was carried by 61 strains(52.59%), blaCTX-M-2 was carried by 2 strains(1.72%), blaCTX-M-8 was carried by 2 strains(1.72%), and blaCTX-M-9 was carried by 89 strains(76.72%). A single beta-lactamase gene was detected in 65 strains(56.03%), two beta-lactamase genes were detected in 31 strains(26.72%), three beta-lactamase genes were detected in 14 strains(12.07%), and various beta-lactamase genes were detected in 6 strains(5.17%). Conclusion BlaCTX-M is the prevalent type of ESBL-producing E. coli in Luzhou, Sichuan. Tazobactam can effectively inhibit beta-lactamases and enhance the antimicrobial activity of piperacillin.
引文
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