福建省多重耐药及产ESBL志贺菌耐药特征分析
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摘要
目的了解福建地区多重耐药和产超广谱β-内酰胺酶(ESBL)志贺菌耐药表型及ESBL相关耐药基因的分布情况。方法收集福建地区2005～2015年志贺菌临床分离株102株,最小抑菌浓度(MIC)法检测药敏情况和产ESBL菌株,聚合酶链反应(PCR)检测ESBL相关耐药基因。结果 102株中97株为多重耐药志贺菌(Multidrug resistance shigella,MDRS),对7种抗菌素耐药率>70.00%。在11年间,头孢类抗生素、氨曲南的耐药率出现先上升后下降的趋势;而庆大霉素和复方新诺明的耐药率出现缓慢下降的趋势。检出产ESBL志贺菌24株(23.53%、24/102),其中福氏8株,宋内16株,CTX-M-Ⅰ、CTX-M-Ⅱ、CTX-M-Ⅳ、TEM、SHV和OXA在产ESBL和不产ESBL志贺菌中均有检出;CTX-M-Ⅱ、CTX-M-Ⅳ和SHV在产ESBL和不产ESBL志贺菌中的分布差异有统计学意义(P<0.01)。结论福建地区多重耐药和产ESBL志贺菌流行广泛;多种耐药基因可能在志贺菌产ESBL的耐药机制中发挥重要作用。
Objective To understand the drug resistance phenotype,patterns of extended-spectrum beta lactamase(ESBL) resistance genes of multi-drug resistance(MDR) and ESBL-producing shigella clinical isolates in Fujian province. Methods A total of 102 isolates were collected during 2005-2015.The minimum inhibitory concentration(MIC) method was used to perform antimicrobial susceptibility test and determine ESBL producing strains.Polymerase chain reaction(PCR) was used to detect ESBL resistance genes. Results A total of 97 strains(97/102) were found to be multidrug-resistant shigella,with the resistance rates to the 7 antimicrobials of >70%.In the past 11 years,the drug resistance rates of cephalosporin and aztreonam increased firsty and then decreased,while them of gentamicin and trimethoprim/sulfamethoxazole decreased slowly.There was 23.53%(24/102) ESBL-producing isolates were detected,among which 8 were S.flexneri and 16 were S.sonnei.CTX-M-Ⅰ,Ⅱ,Ⅳ,TEM,SHV and OXA were detected both in the ESBL-producing and non ESBL-producing isolates.There was statistical significant difference between the ESBL-producing and non ESBL-producing isolates in the distribution of gene CTX-M-Ⅱ,CTX-M-Ⅳ and SHV(P<0.05). Conclusion Multidrug-resistant and ESBL-producing shigella isolates are prevalent in Fujian province.A number of ESBL genes may play an important role in the mechanism of ESBL-producing resistance of shigella.
Objective To understand the drug resistance phenotype,patterns of extended-spectrum beta lactamase(ESBL) resistance genes of multi-drug resistance(MDR) and ESBL-producing shigella clinical isolates in Fujian province. Methods A total of 102 isolates were collected during 2005-2015.The minimum inhibitory concentration(MIC) method was used to perform antimicrobial susceptibility test and determine ESBL producing strains.Polymerase chain reaction(PCR) was used to detect ESBL resistance genes. Results A total of 97 strains(97/102) were found to be multidrug-resistant shigella,with the resistance rates to the 7 antimicrobials of >70%.In the past 11 years,the drug resistance rates of cephalosporin and aztreonam increased firsty and then decreased,while them of gentamicin and trimethoprim/sulfamethoxazole decreased slowly.There was 23.53%(24/102) ESBL-producing isolates were detected,among which 8 were S.flexneri and 16 were S.sonnei.CTX-M-Ⅰ,Ⅱ,Ⅳ,TEM,SHV and OXA were detected both in the ESBL-producing and non ESBL-producing isolates.There was statistical significant difference between the ESBL-producing and non ESBL-producing isolates in the distribution of gene CTX-M-Ⅱ,CTX-M-Ⅳ and SHV(P<0.05). Conclusion Multidrug-resistant and ESBL-producing shigella isolates are prevalent in Fujian province.A number of ESBL genes may play an important role in the mechanism of ESBL-producing resistance of shigella.
引文
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[15] Li J,Li B,Ni Y,et al.Molecular characterization of the extended-spectrum beta-lactamase (ESBL)-producing Shigella spp.in Shanghai[J].Eur J Clin Microbiol Infect Dis,2015,34(3):447-451.
[16] Aggarwal P,Uppal B,Ghosh R,et al.Multi drug resistance and Extended Spectrum Beta Lactamases in clinical isolates of Shigella:A study from New Delhi,India[J].Travel Med Infect Dis,2016,14(4):407-413.
[17] 沈继录,潘亚萍,徐元宏,等.2005～2014年CHINET大肠埃希菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):129-140.
[18] Spanu T,Luzzaro F,Perilli M.Occurrence of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae in Italy:implications for resistance to beta-lactams and other antimicrobial drugs[J].Antimicrob Agents Chemother,2002,46(1):196-202.
[19] Bush K,Jacoby GA.Updated functional classification of beta-lactamases[J].Antimicrobial Agents and Chemotherapy,2010,54(3):969-976.
[20] Ur Rahman S,Ali T,Ali I,et al.The Growing Genetic and Functional Diversity of Extended Spectrum Beta-Lactamases[J].Biom-ed Res Int,2018,26:9519718.
[21] Hawkey PM,Jones AM.The changing epidemiology of resistance[J].J Antimicrob Chemother,2009,64(Suppl 1):3-10.
[22] D'Andrea MM,Arena F,Pallecchi L,et al.CTX-M-type β-lactamases:a successful story of antibiotic resistance[J].Int J Med Microbiol,2013,303(6-7):305-317.
[2] Kotloff KL,Winickoff JP,Ivanoff B,et al.Global burden of Shigella infections:Implications for vaccine development and implementation of control strategies[J].Bull World Health Organ,1999,77(8):651-666.
[3] Taneja N,Mewara A,Kumar A,et al.Cephalosporin-resistant Shigella flexneri over 9 years (2001e09) in India[J].J Antimicrob Chemother,2012,67(6):1 347-1 353.
[4] Lederer I,Taus K,Allerberger F,et al.Shigellosis in refugees,Austria,July to November 2015[J].Euro Surveill,2015,20(48):30 081.
[5] Tansarli GS,Poulikakos P,Kapaskelis A,et al.Proportion of extended-spectrum β-lactamase (ESBL)-producing isolates among Enterobacteriaceae in Africa:evaluation of the evidence-systematic review[J].J Antimicrob Chemother,2014,69(5):1 177-1 184.
[6] 罗朝晨,陈爱平,杨劲松,等.2010～2013年福建省细菌性痢疾监测分析[J].预防医学论坛,2014,20(7):544-546.
[7] Melvin P,Jean B,Shelley Campeau,et al.Clinical and Laboratory Standards Institute.2018.Performance standards for antimicrobial susceptibility testing[S].28th information supplement.M100-S28.
[8] Pitout JD,Hossain A,Hanson ND.Phenotypic and molecular detection of CTX-M-beta-lactamases produced by Escherichia coli and Klebsiella spp[J].J Clin Microbiol,2004,42(12):5 715-5 721.
[9] Inna Chmelnitsky,Yehuda Carmeli,Azita Leavitt,et al.CTX-M-2 and a New CTX-M-39 Enzyme Are the Major Extended-Spectrum Beta-Lactamases in Multiple Escherichia coli Clones Isolated in Tel Aviv,Israel[J].Antimicrob Agents Chemother,2005,49(11):4 745-4 750.
[10] Schlesinger J,Navon-Venezia S,Chmelnitsky I,et al.Extended-spectrum beta-lactamases among Enterobacter isolates obtained in Tel Aviv,Israel[J].Antimicrob Agents Chemother,2005,9(3):1 150-1 156.
[11] Nordmann P,Naas T.Sequence analysis of PER-1 extended-spectrum beta-lactamase from Pseudomonas aeruginosa and comparison with class A beta-lactamases[J].Antimicrob Agents Chemother,1994,38(1):104-114.
[12] Ahmed AM,Furuta K,Shimomura K,et al.Genetic characterization of multidrug resistance in Shigella spp.from Japan[J].Journal of medical microbiology,2006,55(12):1 685-1 691.
[13] 常昭瑞,孙强正,裴迎新,等.2012年中国大陆地区细菌性痢疾疫情特点与监测结果分析[J].疾病监测,2014,29(7):528-532.
[14] Shiferaw B,Solghan S,Palmer A,et al.Antimicrobial susceptibility patterns of Shigella isolates in foodborne diseases active surveillance network (FoodNet) sites,2000-2010[J].Clin Infect Dis,2012,54(Suppl 5):S458e63.
[15] Li J,Li B,Ni Y,et al.Molecular characterization of the extended-spectrum beta-lactamase (ESBL)-producing Shigella spp.in Shanghai[J].Eur J Clin Microbiol Infect Dis,2015,34(3):447-451.
[16] Aggarwal P,Uppal B,Ghosh R,et al.Multi drug resistance and Extended Spectrum Beta Lactamases in clinical isolates of Shigella:A study from New Delhi,India[J].Travel Med Infect Dis,2016,14(4):407-413.
[17] 沈继录,潘亚萍,徐元宏,等.2005～2014年CHINET大肠埃希菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):129-140.
[18] Spanu T,Luzzaro F,Perilli M.Occurrence of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae in Italy:implications for resistance to beta-lactams and other antimicrobial drugs[J].Antimicrob Agents Chemother,2002,46(1):196-202.
[19] Bush K,Jacoby GA.Updated functional classification of beta-lactamases[J].Antimicrobial Agents and Chemotherapy,2010,54(3):969-976.
[20] Ur Rahman S,Ali T,Ali I,et al.The Growing Genetic and Functional Diversity of Extended Spectrum Beta-Lactamases[J].Biom-ed Res Int,2018,26:9519718.
[21] Hawkey PM,Jones AM.The changing epidemiology of resistance[J].J Antimicrob Chemother,2009,64(Suppl 1):3-10.
[22] D'Andrea MM,Arena F,Pallecchi L,et al.CTX-M-type β-lactamases:a successful story of antibiotic resistance[J].Int J Med Microbiol,2013,303(6-7):305-317.