大肠埃希菌耐药特征及质粒介导喹诺酮耐药基因分布
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摘要
目的调查临床分离大肠埃希菌的耐药特征及质粒介导喹诺酮耐药(PMQR)基因流行状况。方法收集本院住院患者分离的大肠埃希菌191株,经VITEK 2全自动鉴定药敏仪进行鉴定和药敏分析,PCR检测PMQR基因qnrA、qnrB、qnrC、qnrD、qnrS、aac(6′)-Ib-cr、oqxA、oqxB、qepA。接合试验分析PMQR基因的转移性。结果 191株菌株对美洛培南和亚胺培南均敏感。对阿米卡星、奈替米星、阿莫西林/克拉维酸、哌拉西林/他唑巴坦和头孢西丁耐药率均低于30%。环丙沙星耐药率为64.4%,PMQR基因检出率为37.7%,123株环丙沙星耐药株中qnrA阳性26.0%、qnrB阳性4.9%、qnrS阳性1.6%、aac(6′)-Ib-cr阳性43.1%、oqxA阳性8.9%、qepA阳性4.9%,未检出到qnrC、qnrD和oqxB。其中40株(32.5%)只检测到单一基因,其余32株(26.0%)检测到2种或2种以上PMQR基因。接合试验证明43株细菌携带的PMQR基因可转移。结论本院分离大肠埃希菌耐药较严重且呈多药耐药,对环丙沙星耐药较高,PMQR基因以qnr和aac(6′)-Ib-cr为主。
Objective To investigate the resistance profile and the prevalence of plasmid-mediated quinolone resistance(PMQR) genes in E.coli isolates. Methods The E.coli strains isolated from hospitalized patientswere collected. Isolates of identification and antibiotic susceptibility were analyzed by the Vitek 2 system. Plasmid mediated quinolone resistant genes qnrA, qnrB, qnrC, qnrD, qnrS, aac(6′)-Ib-cr, qepA, oqxA and oqxB were detected by the PCR. The transfterability of the plasmids harboring PMQR genes were investigated by conjugation test. Results In 191 isolates, all strains were sensitive to meropenem and imipenem. The resistance rates of amicacin, nitimisin, amoxicillin-clavic acid, piperoxicillin-tazobartan and ceficidine were all lower than 30%, while the resistance rate to other antibiotics were higher. The resistance rate of ciprofloxacin was 64.4%, Moreover,72 out of the 191 isolates(37.7%) were found to carry the PMQRs and a further 26.0%, 4.9%, 1.6%, 43.1%, 8.9% and 4.9% in123 ciprofloxacin resistance isolates carried qnrA, qnrB, qnrS, aac(6′)-Ib-cr, oqxA and qepA, qnrC, qnrD and oqxB genes were not detected in ciprofloxacin resistant isolates. Of the 40 isolates(32.5%), only one PMQR gene was detected, while the remaining 32 iaolates(26.0%) detected two or more PMQR genes. 43 isolates carrying the transferable plasmids.Conclusion The resistance of E.coli isolates in our hospital was severe and showed multi-drug resistance, and the resistance rate to ciprofloxacin was high. The PMQR genes were mainly qnr and aac(6′)-Ib-cr.
Objective To investigate the resistance profile and the prevalence of plasmid-mediated quinolone resistance(PMQR) genes in E.coli isolates. Methods The E.coli strains isolated from hospitalized patientswere collected. Isolates of identification and antibiotic susceptibility were analyzed by the Vitek 2 system. Plasmid mediated quinolone resistant genes qnrA, qnrB, qnrC, qnrD, qnrS, aac(6′)-Ib-cr, qepA, oqxA and oqxB were detected by the PCR. The transfterability of the plasmids harboring PMQR genes were investigated by conjugation test. Results In 191 isolates, all strains were sensitive to meropenem and imipenem. The resistance rates of amicacin, nitimisin, amoxicillin-clavic acid, piperoxicillin-tazobartan and ceficidine were all lower than 30%, while the resistance rate to other antibiotics were higher. The resistance rate of ciprofloxacin was 64.4%, Moreover,72 out of the 191 isolates(37.7%) were found to carry the PMQRs and a further 26.0%, 4.9%, 1.6%, 43.1%, 8.9% and 4.9% in123 ciprofloxacin resistance isolates carried qnrA, qnrB, qnrS, aac(6′)-Ib-cr, oqxA and qepA, qnrC, qnrD and oqxB genes were not detected in ciprofloxacin resistant isolates. Of the 40 isolates(32.5%), only one PMQR gene was detected, while the remaining 32 iaolates(26.0%) detected two or more PMQR genes. 43 isolates carrying the transferable plasmids.Conclusion The resistance of E.coli isolates in our hospital was severe and showed multi-drug resistance, and the resistance rate to ciprofloxacin was high. The PMQR genes were mainly qnr and aac(6′)-Ib-cr.
引文
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[5] 黄丽,高晓坤,张宏.肠杆菌科细菌质粒介导喹诺酮类耐药基因的检测[J].中国感染与化疗杂志,2014,14(4):286-290.
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[9] 石磊,段博文,高进贤,等.大肠埃希菌对喹诺酮类药物的耐药机制分析[J].中华医院感染学杂志,2017,27(20):4568-4571.
[10] Hu F,O’hara JA,Rivera JI,et al.Molecular features of community-associated extended-spectrum β-lactamase-producing E.coIi strains in the United States[J].Antimicrob Agents Chemother,2014,58(11):6953-6957.
[11] Ferjani S,Saidani M,Amine FS,et al.Prevalence and characterization of plasmid-mediated quinolone resistance genes in extended-spectrum blactamase β-producing enterobacteriaceae in a Tunisian hospital[J].Microb Drug Resist,2015,21(2):158-166.
[12] 倪慧群,赵丽丽,方中飞,等.院感染革兰阴性杆菌产超广谱β-内酰胺酶、AmpC酶耐药性研究[J].中国卫生检验杂志,2017,27(5):733-735.
[13] Zurfluh K,Abgottspon H,H?chler H,et al.Quinolone resistance mechanisms among extended-spectrum beta-lactamase (ESBL) producing E.coli isolated from rivers and lakes in Switzerland[J].PLoS ONE,2014,9(4):e95864-e95876.
[14] 毛小琴,苑荣亮.医院肠杆菌科细菌质粒介导喹诺酮耐药机制研究[J].中国病原生物学杂志,2017,12(12):1140-1143.
[15] 兰芳俊,吴娟,何清雯,等.临床分离大肠埃希菌质粒介导喹诺酮耐药基因和β-内酰胺酶基因检测[J].中国感染与化疗杂志,2017,17(3):293-297.
[2] Ferjani S,Saidani M,Amine FS,et al.Prevalence and characterization of plasmid-mediated qumolone resistance genes in extended-spectrum 13-1actamase-produeing Enterobacteriaceae in a Tunisian hospital[J].Microb Drug Resist,2015,21(2):158-166.
[3] 茆海丰,刘洪,赵勇,等.大肠埃希菌对喹诺酮类抗菌药物耐药机制研究[J].中华医院感染学杂志,2015,25(15):3375-3377.
[4] 潘玫,陈山,李稳.大肠埃希菌耐药特征及质粒介导喹诺酮耐药基因分布[J].中国感染与化疗杂志,2016,16(1):15-19.
[5] 黄丽,高晓坤,张宏.肠杆菌科细菌质粒介导喹诺酮类耐药基因的检测[J].中国感染与化疗杂志,2014,14(4):286-290.
[6] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-fourth informational supplement [S].PA:CLSI,2016.
[7] 阮荣华,段达荣,叶雅丽,等.门诊患者尿液分离大肠埃希菌喹诺酮类耐药机制研究[J].中国卫生检验杂志,2017,27(22):3319-3320,3340.
[8] 汪群水,周学琴,李丽民.从患者胆汁分离的大肠埃希菌中质粒介导的氟喹诺酮类耐药基因的检测[J].疾病监测,2015,30(6):493-496.
[9] 石磊,段博文,高进贤,等.大肠埃希菌对喹诺酮类药物的耐药机制分析[J].中华医院感染学杂志,2017,27(20):4568-4571.
[10] Hu F,O’hara JA,Rivera JI,et al.Molecular features of community-associated extended-spectrum β-lactamase-producing E.coIi strains in the United States[J].Antimicrob Agents Chemother,2014,58(11):6953-6957.
[11] Ferjani S,Saidani M,Amine FS,et al.Prevalence and characterization of plasmid-mediated quinolone resistance genes in extended-spectrum blactamase β-producing enterobacteriaceae in a Tunisian hospital[J].Microb Drug Resist,2015,21(2):158-166.
[12] 倪慧群,赵丽丽,方中飞,等.院感染革兰阴性杆菌产超广谱β-内酰胺酶、AmpC酶耐药性研究[J].中国卫生检验杂志,2017,27(5):733-735.
[13] Zurfluh K,Abgottspon H,H?chler H,et al.Quinolone resistance mechanisms among extended-spectrum beta-lactamase (ESBL) producing E.coli isolated from rivers and lakes in Switzerland[J].PLoS ONE,2014,9(4):e95864-e95876.
[14] 毛小琴,苑荣亮.医院肠杆菌科细菌质粒介导喹诺酮耐药机制研究[J].中国病原生物学杂志,2017,12(12):1140-1143.
[15] 兰芳俊,吴娟,何清雯,等.临床分离大肠埃希菌质粒介导喹诺酮耐药基因和β-内酰胺酶基因检测[J].中国感染与化疗杂志,2017,17(3):293-297.