太原地区产超广谱β-内酰胺酶大肠埃希菌的流行趋势和耐药机制
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摘要
目的
分析太原地区产ESBL大肠埃希菌流行趋势和耐药机制,为指导临床合理使用抗生素,减少耐药菌株在本地区扩散及流行病研究提供实验依据和指导。
方法
1对临床分离的耐药菌株进行纸片扩散法ESBL表型筛选,将筛选出68株ESBL表型阳性菌重新进行生化鉴定、药敏实验。
2用PCR方法对产ESBL大肠埃希菌进行分型并测序。
3用三维实验、多重PCR的方法对耐头孢西丁的产ESBL大肠埃希菌进行AmpCβ-内酰胺酶的检测。
4 SDS-PAGE对部分菌株外膜蛋白进行分离鉴定。
5 ERIC—PCR的方法流行病学分型。
6 PCR方法对整合酶及其基因盒进行分析并测序。
结果
1临床收集耐药大肠埃希氏菌株中,通过ESBL表型确证试验共筛选出68株ESBL阳性菌株。其中门诊病人10株,住院病人58株。其中外科病房分离占2/3。
2 PCR结果TEM型67株为阳性,SHV型04LE030阳性,测序为SHV12, CTX-M2、OXA1、OXA2、OXA10引物PCR电泳未见阳性。CTX-M1阳性21株,CTX-M9阳性48株。
3 AMPC三维实验04LE030弱阳性,多重PCR结果04LE030阳性带在400BP左右,测序为DHA1。
4 SDS-PAGE可见04LE048出现OmpF缺失出现大分子蛋白条带。
5.ERIC—PCR的方法显示不同医院菌株流行病学分型有差异。
6整合酶ⅠPCR阳性39株,整合酶ⅡPCR阳性1株,其基因盒有两种结构,均包括
氨基糖苷类抗生素和磺胺类抗生素的耐药的基因。结论
1产ESBL大肠埃希菌引起的感染以泌尿系统和呼吸道感染为主,住院病人以外科病房为主,门诊病人泌尿系统老人多见。
2本地区产ESBL大肠埃希菌以CTX-M9群、CTX-M1群为主。表型筛选时可使用头孢噻肟和氨曲南,确证可只使用头孢噻肟和头孢噻肟+棒酸。单头孢他定和头孢他定+棒酸表型确证试验阳性的大肠高度怀疑为SHV型。
3本地区同时产ESBL和AmpC大肠埃希菌还不多见;头孢西丁完全耐药(直径=6mm)
Objective:
Investigate the mechanisms of drug-resistance and epidemiology of Escherichia coli.These strains producing extended-spectrumβ-lactamases come from taiyuan. With a view to provide the experimental reference and guideline for judicious use of antibiotics.
Methods:
1.ESBLs-producing strains were confirmed by the NCCLS phenotypic confirmatory test using disc agar diffusion method (Kirby-Bauer diffusion test).
2. PCR amplification of ESBLs genes, then direct analysis DNA sequencing.
3.Using three-dimension method and mutiPCR detection of AmpC-β-lactamases . The strains were cefoxitin drug-resistance.
4.Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) isolation and analysis outer membrane protein of some strains.
5. Useing ERIC2-PCR analysis epidemiological investigations. 6.PCR amplification of integrase and Genecassettes genes, then direct DNA sequencing analysis.
Results
1. 68 ESBLs-producing strains were confirmed by the NCCLS phenotypic confirmatory test using Kirby-Bauer diffusion test.10 strains isolation from outpatient ,other isolation from inpatients ,surgery ward accounting for 2/3.
2 .The PCR results of gene in plasmid DNA showed that TEM positive was 67 strains, The sequence showed 100% amino acid identity to TEM-1. SHV positive was 04LE30, The sequence showed identity to SHV-12. CTX-M2、OXA1、OXA2、OXA10 all are negative. CTX-M 1 showed 21 strains positive .CTX-M 9 positive was 48 strains.
3 .Detection three-dimension method of AmpC-β-lactamases ,04LE30 was positive,mutiPCR show a bind at 400bp ,The sequence showed identity to DHA1.
4. Omp profile analysis showed that OmpF expression presented diminution or deletion in some ESBL-producing strains.04LE048 OmpC expression presented deletion and has a new
分析太原地区产ESBL大肠埃希菌流行趋势和耐药机制,为指导临床合理使用抗生素,减少耐药菌株在本地区扩散及流行病研究提供实验依据和指导。
方法
1对临床分离的耐药菌株进行纸片扩散法ESBL表型筛选,将筛选出68株ESBL表型阳性菌重新进行生化鉴定、药敏实验。
2用PCR方法对产ESBL大肠埃希菌进行分型并测序。
3用三维实验、多重PCR的方法对耐头孢西丁的产ESBL大肠埃希菌进行AmpCβ-内酰胺酶的检测。
4 SDS-PAGE对部分菌株外膜蛋白进行分离鉴定。
5 ERIC—PCR的方法流行病学分型。
6 PCR方法对整合酶及其基因盒进行分析并测序。
结果
1临床收集耐药大肠埃希氏菌株中,通过ESBL表型确证试验共筛选出68株ESBL阳性菌株。其中门诊病人10株,住院病人58株。其中外科病房分离占2/3。
2 PCR结果TEM型67株为阳性,SHV型04LE030阳性,测序为SHV12, CTX-M2、OXA1、OXA2、OXA10引物PCR电泳未见阳性。CTX-M1阳性21株,CTX-M9阳性48株。
3 AMPC三维实验04LE030弱阳性,多重PCR结果04LE030阳性带在400BP左右,测序为DHA1。
4 SDS-PAGE可见04LE048出现OmpF缺失出现大分子蛋白条带。
5.ERIC—PCR的方法显示不同医院菌株流行病学分型有差异。
6整合酶ⅠPCR阳性39株,整合酶ⅡPCR阳性1株,其基因盒有两种结构,均包括
氨基糖苷类抗生素和磺胺类抗生素的耐药的基因。结论
1产ESBL大肠埃希菌引起的感染以泌尿系统和呼吸道感染为主,住院病人以外科病房为主,门诊病人泌尿系统老人多见。
2本地区产ESBL大肠埃希菌以CTX-M9群、CTX-M1群为主。表型筛选时可使用头孢噻肟和氨曲南,确证可只使用头孢噻肟和头孢噻肟+棒酸。单头孢他定和头孢他定+棒酸表型确证试验阳性的大肠高度怀疑为SHV型。
3本地区同时产ESBL和AmpC大肠埃希菌还不多见;头孢西丁完全耐药(直径=6mm)
Objective:
Investigate the mechanisms of drug-resistance and epidemiology of Escherichia coli.These strains producing extended-spectrumβ-lactamases come from taiyuan. With a view to provide the experimental reference and guideline for judicious use of antibiotics.
Methods:
1.ESBLs-producing strains were confirmed by the NCCLS phenotypic confirmatory test using disc agar diffusion method (Kirby-Bauer diffusion test).
2. PCR amplification of ESBLs genes, then direct analysis DNA sequencing.
3.Using three-dimension method and mutiPCR detection of AmpC-β-lactamases . The strains were cefoxitin drug-resistance.
4.Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) isolation and analysis outer membrane protein of some strains.
5. Useing ERIC2-PCR analysis epidemiological investigations. 6.PCR amplification of integrase and Genecassettes genes, then direct DNA sequencing analysis.
Results
1. 68 ESBLs-producing strains were confirmed by the NCCLS phenotypic confirmatory test using Kirby-Bauer diffusion test.10 strains isolation from outpatient ,other isolation from inpatients ,surgery ward accounting for 2/3.
2 .The PCR results of gene in plasmid DNA showed that TEM positive was 67 strains, The sequence showed 100% amino acid identity to TEM-1. SHV positive was 04LE30, The sequence showed identity to SHV-12. CTX-M2、OXA1、OXA2、OXA10 all are negative. CTX-M 1 showed 21 strains positive .CTX-M 9 positive was 48 strains.
3 .Detection three-dimension method of AmpC-β-lactamases ,04LE30 was positive,mutiPCR show a bind at 400bp ,The sequence showed identity to DHA1.
4. Omp profile analysis showed that OmpF expression presented diminution or deletion in some ESBL-producing strains.04LE048 OmpC expression presented deletion and has a new
引文
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[4] Mammeri, H,Laurans G,Eveillard M,et al. Coexistence of SHV-4-and TEM-24-Producing Enterobacter aerogenes Strains before a Large Out break of TEM-24-Producing Strains in a French Hospital[J]. J . clin. microbial ,2001, 39(6):2184–2190
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[2] Lixin Z, Betsy F, Carl M.Both Urinaryand Rectal Escherichia coli Isolates Are Dominated by Strains of Phylogenetic Group B2[J]. J . clin. microbial ,2002, 40(11):3951–3955
[3] Sanchez, S, Mccrackin S, M.A, et al.Characterization of Multidrug-Resistant Escherichia coli Isolates Associated with Nosocomial Infectionsin Dogs[J]. J . clin. microbial ,2002, 40(10):3586–3595
[4] Mammeri, H,Laurans G,Eveillard M,et al. Coexistence of SHV-4-and TEM-24-Producing Enterobacter aerogenes Strains before a Large Out break of TEM-24-Producing Strains in a French Hospital[J]. J . clin. microbial ,2001, 39(6):2184–2190
[5] Lee SH, Kim JY, Shin S H, et.al. Dissemination of SHV-12 and Characterization of New AmpCβ-Type Beta-Lactamase Genes among Clinical Isolates of Enterobacter Species in Korea[J]. J . clin. microbial ,2003, 41( 6): 2477–2482
[6] Olive MD and Bean P.Principles and Applications of Methods for DNA-Based Typing of Microbial Organisms[J]. J . clin. microbial , 1999, 37(6): 1661–1669
[7] Meacham, KJ, Zhang, L., Foxman, B, et.al. Evaluation of Genotyping Large Numbers of Escherichia coli Isolatesby Enterobacterial Repetitive Intergenic Consensus-PCR. [J]. J . clin. microbial ,2003, 41( 11):5224–5226 .
[8] Henriques N B, Normark S.Evolution and spread of antibiotic resistance [J].Journal of Internal Medicine 2002;252:91–106
[9] Perez-Perez FJ, Hanson ND.Detection of Plasmid -Mediated AmpC β -Lactamase Genesin Clinical Isolates by Using Multiplex PCR[J]. J . clin. microbial ,2002,.40(6):2153–2162
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