尿路致病性大肠埃希菌多位点序列分型与耐药谱型的相关性

目的探讨尿路致病性大肠埃希菌（UPEC）的多位点序列分型（MLST）与抗菌药物耐药的关系。 方法以上海中医药大学附属普陀医院2015年3月至2016年12月住院患者为研究对象，收集清洁中段尿样本中分离培养的大肠埃希菌，应用MLST方法进行菌株分型研究。采用Vitek-2 Compact全自动微生物分析系统检测UPEC对7种常用抗菌药物的敏感性及超广谱β-内酰胺酶（ESBLs）。 结果93株UPEC对亚胺培南耐药率为0%，对厄他培南、阿米卡星、哌拉西林/他唑巴坦耐药率为1.1%~3.2%，保持高度敏感性。对头孢他啶、头孢吡肟、氨曲南、庆大霉素和妥布霉素均有一定敏感性，耐药率低于50%。对头孢曲松、环丙沙星、左氧氟沙星和复方SMZ耐药率> 50%。产ESBLs菌株59例（63.4%），ESBLs阴性菌株34株（36.6%）。分离株共有33个已知序列型（STs），1例未知ST型，其中最多的克隆群为ST131（23/93、24.7%），ST648（9/93、9.7%），ST405（7/93、7.5%）和ST1193（7/93、7.5%）。 结论UPEC具有多药耐药性，MLST分型提示UPEC菌株具有多样性，ESBLs与UPEC抗菌药物耐药有一定相关性，ST型与耐药谱型无相关性。

Correlation between genetic typing and drug resistance of uropathogenic Escherichia coli

ObjectivesTo investigate the relationship between the multi-locus sequence typing (MLST) and the antimicrobial resistance of uropathogenic Escherichia coli (UPEC). MethodsUPEC strains were isolated from patients in Putuo Hospital, Shanghai University of Traditional Chinese Medicine from March 2015 to December 2016. The strains were classified by MLST. The susceptibility to 17 kinds of common antimicrobial drugs and ESBLs identification of the UPEC were determined by Vitek-2 Compact. ResultsAmong the 93 UPEC strains, the resistance rates to imipenem were 0%; which were 1.1%-3.2% to ertapenem, amikacin, piperacillin-tazobactam, still with high susceptibility. The resistance rates to ceftazidime, cefepime, ammonia QuNa, gentamicin, tobramycin were all < 50%, which displayed moderate susceptibility. The resistance rates to ceftriaxone, ciprofloxacin, levofloxacin and compound SMZ were all > 50%, which showed high resistance. Among the 93 UPEC strains, 59 (63.4%) strains produced ESBLs, 34 (36.6%) strains didn’t produce ESBLs. There were 33 known and 1 unknown sequence types (STs) detected from the isolated strains. The most frequent sequence types were ST131 (23/93, 24.7%), ST648 (9/93, 9.7%), ST405 (7/93, 7.5%) and ST1193 (7/93, 7.5%). ConclusionsUPEC showed multi-drug resistance, and the MLST classification indicates that the UPEC strain was diverse, and ESBLs had a certain correlation with UPEC antibacterial drug resistance, and ST type had no correlation with drug resistance spectrum.