临床血流感染沙门菌的分型及同源性与耐药性分析
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摘要
目的探讨临床血液感染沙门菌血清分型、基因同源性及耐药质粒和细菌耐药性的关系。方法收集武汉大学中南医院2015～2017年临床血流感染分离的10株沙门菌。采用法国梅里埃Vitek 2Compact全自动鉴定药敏检测系统进行鉴定和药敏实验,按国家标准对沙门菌进行血清学分型,用肠杆菌科基因间重复序列的聚合酶链反应(ERIC-PCR)对其进行基因分型,采用Cluster 3.0软件对PCR扩增产物进行聚类分析。结果 10株沙门菌分为3种血清群,A群1株,B群3株,D群6株,D群是优势血清群,约占60.0%;10株沙门菌中2,3,4,5和8号菌株含有质粒,不含质粒的是1,6,7,9和10号菌株;10株沙门菌对氨苄西林耐药率为80.0%,左氧氟沙星中介率80.0%,对三、四代头孢及碳青霉烯类100.0%敏感,对复方磺胺类敏感率为80.0%;4号和10号菌株、8号和9号菌株的同源性超过80.0%,1号和2号,5号和6号菌株的同源性大于70.0%。结论沙门菌存在耐药质粒,质粒的多少表明耐药程度的高低;沙门菌对氨苄西林及氨苄西林/舒巴坦耐药率较高,对头孢他啶敏感率高,因此治疗血流感染时可选用三、四代头孢或亚胺培南,采用降阶梯治疗。
Objective To investigate the relationship between serotyping,gene homology,drug-resistant plasmids and bacterial resistance of Salmonellain clinical blood infection.Methods 10 strains of Salmonellaisolated from clinical blood stream infection in Zhongnan Hospital of Wuhan University during the past 2015～2017 years were collected.The strains identification and drug sensitive test were performed by French BioMerieux Vitek 2 Compact automatic identification and drug sensitivity detection system,serological typing was carried out according to the national standard,genotyping was conducted by enterobacterial repetitive intergenic consensus sequence polymerase chain reaction(ERIC-PCR),clustering analysis was done using Cluster 3 software for PCR amplification products.Results 10 strains of Salmonella contained 3 serum groups,1 strain of A group,3 strains of B group,6 strains of group D respectively,D group was the dominant serogroup,accounted for60.0%,10 strains of Salmonellacontaining plasmid were strain 2,strain 3,strain 4,strain 5,strain 8,and no plasmid containing bacteria strain 1,strain 6,strain 7,strain 9,strain 10,10 strains Salmonellaresistant rate to ampicillin were 80.0%,levofloxacin intermediary rate reached 80%,but their sensitive rates to the third or fourth generation cephalosporins and carbapenems were 100.0%,their sensitive rate to compound sulfanilamide was 80.0%.The gene homology between strain 4 and strain 10 was more than 80.0%,strain 9 and strain 8 homology was also over 80.0%,the gene homology between strain1 and strain 2 and between strain 5 and strain 6 was over 70.0%.Conclusion There were some plasmids on some Salmonellastrains which implied the level of drug resistance.Salmonella resistance rates to ampicillin and ampicillin/sulbactam were high,but they were very sensitive to ceftazidime,and so the treatment of bloodstream infection has better to select the third or fourth generation ceftazidime or imipenem and employ deescalation therapy strategy.
Objective To investigate the relationship between serotyping,gene homology,drug-resistant plasmids and bacterial resistance of Salmonellain clinical blood infection.Methods 10 strains of Salmonellaisolated from clinical blood stream infection in Zhongnan Hospital of Wuhan University during the past 2015～2017 years were collected.The strains identification and drug sensitive test were performed by French BioMerieux Vitek 2 Compact automatic identification and drug sensitivity detection system,serological typing was carried out according to the national standard,genotyping was conducted by enterobacterial repetitive intergenic consensus sequence polymerase chain reaction(ERIC-PCR),clustering analysis was done using Cluster 3 software for PCR amplification products.Results 10 strains of Salmonella contained 3 serum groups,1 strain of A group,3 strains of B group,6 strains of group D respectively,D group was the dominant serogroup,accounted for60.0%,10 strains of Salmonellacontaining plasmid were strain 2,strain 3,strain 4,strain 5,strain 8,and no plasmid containing bacteria strain 1,strain 6,strain 7,strain 9,strain 10,10 strains Salmonellaresistant rate to ampicillin were 80.0%,levofloxacin intermediary rate reached 80%,but their sensitive rates to the third or fourth generation cephalosporins and carbapenems were 100.0%,their sensitive rate to compound sulfanilamide was 80.0%.The gene homology between strain 4 and strain 10 was more than 80.0%,strain 9 and strain 8 homology was also over 80.0%,the gene homology between strain1 and strain 2 and between strain 5 and strain 6 was over 70.0%.Conclusion There were some plasmids on some Salmonellastrains which implied the level of drug resistance.Salmonella resistance rates to ampicillin and ampicillin/sulbactam were high,but they were very sensitive to ceftazidime,and so the treatment of bloodstream infection has better to select the third or fourth generation ceftazidime or imipenem and employ deescalation therapy strategy.
引文
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[6]严海忠,王娟,罗锡华,等.2012~2016年广东省中山社区鼠伤寒沙门菌同源性分析及对喹诺酮类药物耐药机制研究[J].现代检验医学杂志,2018,33(4):63-66.YAN Haizhong,WANG Juan,LUO Xihua,et al.Study on the homology and resistance mechanism of Salmonella typhimurium to quinolone from 2012~2016in Zhongshan community of Guangdong province[J].Journal of Modern Laboratory Medicine,2018,33(4):63-66.
[7]刘芳萍,蔺月霞,张程程,等.鸡源性多重耐药沙门菌质粒与耐药性相关性分析[J].中国家禽,2014,36(16):26-29.LIU Fangping,LIN Yuexia,ZHANG Chengcheng,et al.Correlation analysis of plasmid and drug resistance of multidrug-resistance Salmonella isolated from chickens[J].China Poultry,2014,36(16):26-29.
[2]刘鲜鲜,王娟,赵建梅,等.南宁地区生猪屠宰环节沙门菌分离株毒力基因检测与耐药性分析[J].畜牧与兽医,2016,48(9):103-107.LIU Xianxian,WANG Juan,ZHAO Jianmei,et al.A-nalysis of resistance and virulence genes of Salmonellaisolated from pig slaughtering process in Nanning area[J].Animal Husbandry&Veterinary Medicine,2016,48(9):103-107.
[3]KARIUKI S,OKORO C,KIIRU J,et al.Ceftriaxoneresistant Salmonella enterica serotype typhimurium sequence type 313from Kenyan patients is associated with the blaCTX-M-15gene on a novel IncHI2plasmid[J].Antimicrob Agents Chemother,2015,59(6):3133-3139.
[4]MACIAS-FARRERA G P,DE OCA JIMENEZ RM,VARELA-GUERRERO J,et al.Antibiotics susceptibility of quinolones against Salmonellaspp.strains isolated and molecularly sequenced for gyra gene[J].Microb Pathog,2018,114:286-290.
[5]LIU L,ZHAO X W,SONG Y M,et al,Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4(903,1832)in SPF chickens[J].Journal of Applied Genetics,2016,57(3):389-396.
[6]严海忠,王娟,罗锡华,等.2012~2016年广东省中山社区鼠伤寒沙门菌同源性分析及对喹诺酮类药物耐药机制研究[J].现代检验医学杂志,2018,33(4):63-66.YAN Haizhong,WANG Juan,LUO Xihua,et al.Study on the homology and resistance mechanism of Salmonella typhimurium to quinolone from 2012~2016in Zhongshan community of Guangdong province[J].Journal of Modern Laboratory Medicine,2018,33(4):63-66.
[7]刘芳萍,蔺月霞,张程程,等.鸡源性多重耐药沙门菌质粒与耐药性相关性分析[J].中国家禽,2014,36(16):26-29.LIU Fangping,LIN Yuexia,ZHANG Chengcheng,et al.Correlation analysis of plasmid and drug resistance of multidrug-resistance Salmonella isolated from chickens[J].China Poultry,2014,36(16):26-29.