2010-2018年安徽省马鞍山市腹泻患者中非伤寒沙门菌的分子分型与耐药性研究

目的 了解马鞍山地区腹泻监测人群非伤寒沙门菌的感染状况、血清学分布、分子分型与耐药性等特征。方法 对2010-2018年腹泻患者中分离的非伤寒沙门菌进行血清学分型、脉冲场凝胶电泳(PFGE)和药物敏感性试验。结果 从2 998例腹泻患者中检出非伤寒沙门菌腹泻263例(8.8%),其中2例为2种非伤寒沙门菌混合感染;6-7月份非伤寒沙门菌感染率较高,05岁年龄组感染率最高(15.9%)(χ²=72.98,P<0.001);265株非伤寒沙门菌分为36个血清型,优势血清型为阿贡纳沙门菌、肠炎沙门菌和鼠伤寒沙门菌;阿贡纳沙门菌的PFGE带型分布较集中,有菌株成簇存在的现象;测试菌株总耐药率为95.6%(66/69),多重耐药率为82.6%(57/69);测试菌株对AMP(79.7%)、STR(75.3%)和Sul(66.6%)耐药率较高,对AMI和AZI 完全敏感;发现2株ESBLs的菌株,均为多重耐药菌株;鼠伤寒沙门菌和肠炎沙门菌对不同药物的敏感性有所不同,前者对喹诺酮类药物较敏感,而后者对四环素类药物较敏感。结论 马鞍山地区优势血清型为阿贡纳沙门菌,与其他地区不同。阿贡纳沙门菌有成簇存在的情况,提示有既往暴发的可能。总耐药及多重耐药现象严重,应谨慎用药并加强对病例的耐药监测。     

兰州地区腹泻患儿沙门菌耐药性与分子分型分析

目的 了解兰州地区腹泻患儿沙门菌的血清型分布特征,耐药状况及分子分型特征,为儿童沙门菌感染的防治提供依据。方法 2018-2020年收集兰州地区哨点医院腹泻患儿粪便标本中分离的149株沙门菌菌株进行血清学分型、药物敏感试验和脉冲场电泳分型。结果 腹泻患儿感染沙门菌以夏秋季为主,1~3岁幼儿居多,占59.73%。149株沙门菌分为33个血清型,其中肠炎沙门菌和鼠伤寒沙门菌为优势血清型,分别占30.87%和28.19%。沙门菌对氨苄西林耐药率最高为79.87%,多重耐药率为78.52%,其中鼠伤寒沙门菌和肠炎沙门菌多重耐药率分别为80.95%、76.09%。经PFGE分子分型将肠炎沙门菌分为20个带型,包含2株及以上的带型有6种;鼠伤寒沙门菌分为30个带型,ST1带型包含2株菌。结论 兰州市腹泻患儿中沙门菌以非伤寒沙门菌为主,耐药率呈上升趋势,多重耐药严重,肠炎沙门菌PFGE分型同源性较高,鼠伤寒沙门菌带型呈多样性分布。     

成都市人源沙门菌基因组特征分析

目的 基于全基因组测序技术,探究成都市人源沙门菌的基因组特征, 为监测与预防沙门菌感染提供资料。方法 收集35株成都市人源沙门菌(分离自腹泻患者粪便)进行全基因组测序。根据测序数据,进行血清型预测、耐药基因及可移动遗传元件预测、毒力因子注释及分布分析。结果 35株沙门菌分离株经全基因组测序,共预测到5种血清型,包括15株I 4,[5],12:i:-沙门菌(13株为ST34、2株为新ST型)、12株鼠伤寒沙门菌(ST19)、5株肠炎沙门菌(ST11)、2株德比沙门菌(ST40)与1株火鸡沙门菌(ST463)。35株沙门菌分离株共预测到10类42种不同的耐药基因,其中氨基糖苷类aac(6')-Iaa携带率为100%(35/35)。I 4,[5],12:i:-沙门菌的耐药基因、质粒及插入序列数目及种类多于其他血清型菌株。I 4,[5],12:i:-、鼠伤寒沙门菌和肠炎沙门菌的毒力因子数目大于其他血清型菌株。部分鼠伤寒沙门菌有更高的毒力质粒、质粒编码菌毛和血清抗性毒力因子分布。结论 成都市人源沙门菌不同血清型菌株之间耐药基因、可移动遗传元件、毒力因子分布差异明显,值得在转录组、蛋白组进一步探究其耐药与毒力机制。     

2011-2013年河南省鼠伤寒沙门菌耐药与分子分型研究

目的 分析2011-2013年河南省鼠伤寒沙门菌临床分离株的耐药状况与脉冲场凝胶电泳(PFGE)分子分型带型,为以鼠伤寒沙门菌为代表的食源性疾病暴发预警、调查、溯源及公共卫生意义上的抗生素使用策略提供基线与参考数据。方法 根据国际PulseNet 细菌性传染病分子分型监测网络公布的沙门菌PFGE分型技术与美国临床与实验室标准协会(CLSI)沙门菌K-B法药敏测试方案,对2011-2013年分离自我省5个哨点医院的72株鼠伤寒沙门菌进行13种抗生素的药敏测试与PFGE分子分型分析。结果 72株沙门菌对8类13种抗生素均有不同程度的耐药,有65株为多重耐药菌株(90.3%),其中耐3~5种的为6株(8.3%),耐6~8种的为34株(47.2%),耐9~10种的为10株(13.9%)。72株鼠伤寒沙门菌经Xba Ⅰ酶切与脉冲场凝胶电泳后,获得45种带型,每种带型包含菌株数1~9株不等,相似度区间为65.6%~100%。结论 河南省临床分离的鼠伤寒沙门菌耐药状况普遍比较严重,PFGE带型呈现出多样性的同时又具有较显著的优势带型特点,部分带型与其对应的耐药谱具有一定的关联性与相同的聚集性。     

婴幼儿腹泻人群中鼠伤寒沙门菌的流行病学及多重耐药特征研究

目的 了解2014-2018年徐州地区婴幼儿腹泻患者中鼠伤寒沙门菌的流行病学特征和耐药特征,提高对鼠伤寒沙门菌肠炎的流行及耐药性的认识。方法 收集2014—2018年徐州市医院门诊就诊的婴幼儿(0~3岁)腹泻粪便标本,进行沙门菌病原学检测,用描述流行病学方法对鼠伤寒沙门菌的流行特征进行分析。用最低抑菌浓度法测定鼠伤寒沙门菌对常见抗生素的敏感性,用双纸片协同法来确定产超广谱β-内酰胺酶(ESBLs)耐药表型,用PFGE进行分子分型研究。结果 1 343份腹泻标本中检出178株沙门氏菌,其中鼠伤寒沙门菌为72株(5.36%);5年间,沙门菌(χ趋势2=21.23,P<0.01)和鼠伤寒沙门菌检出率呈逐年上升趋势(χ趋势2=16.02,P<0.01);鼠伤寒血清型在沙门菌中的占比为40.45%,亦呈逐年增高的趋势(χ趋势2=18.47,P<0.01)。90.28%的鼠伤寒沙门菌为多重耐药菌,对临床首选儿科用药—头孢他定(25.0%)和头孢曲松(37.50%)的耐药率均高于20%;产ESBLs表型阳性株对氨苄西林/他唑巴坦(χ²=4.57,P<0.05)、头孢吡肟(χ²=38.66,P<0.01)、氨曲南(χ²=45.53, P<0.01)的耐药率高于非产ESBLs表型株。9株多重耐药鼠伤寒沙门菌出现4簇100%一致PFGE带型。结论 近5年,婴幼儿腹泻患者中鼠伤寒沙门菌感染率较高,多重耐药现象严重,存在小范围传播的可能。     

澳门地区鸡源性产超广谱β-内酰胺酶大肠埃希菌基因型检测

目的 了解澳门地区鸡源性产超广谱β-内酰胺酶(Extended-spectrum β-lactamases, ESBLs)大肠埃希菌的基因型。方法 采用方便抽样的方法购买澳门地区市售的69个鸡源性产品,从中分离鉴定出103株产ESBLs大肠埃希菌,分别用CTX-M、TEM、OXA和SHV的引物对其进行PCR扩增,以此来判断它们的基因型,并用限制性片段长度多态性(RFLP)的方法对CTX-M型的产ESBLs大肠埃希菌进行初步分群, 并以纸片扩散法进行药敏试验。结果 澳门地区89.8%(62/69)鸡源性产品检测出产ESBLs大肠埃希菌,103株产ESBLs大肠埃希菌,经PCR扩增后,非重复株有84株,结果显示CTX-M型、TEM型、OXA型和SHV型分别占98.8%(83/84)、25.0%(21/84)、3.6%(3/84)和0.0%(0/84);其中23.8%(20/84)同时携带CTX-M型和TEM型,3.6%(3/84)同时携带CTX-M型和OXA型。83株CTX-M型的产ESBLs大肠埃希菌中66.3%(55/83)为CTX-M-G1,31.3%(26/83)为CTX-M-G9,CTX-M-G2和CTX-M-G8的检出率均为1.2%(1/83)。药敏试验中亚胺培南和美罗培南全部菌株敏感, 氨苄西林耐药率最高达98.8%, 其次为四环素83.3%(70/84)和阿米卡星78.6%(66/84)。结论 澳门地区鸡源性产ESBLs大肠埃希菌的检出率较高,其基因型以 CTX-M型为主,其次为TEM型,其中CTX-M型分群中以CTX-M-G1为主, 多重耐药的ESBLs大肠菌株普遍存在。     

深圳市腹泻患者沙门菌感染状况和耐药性分析

目的 分析2014-2017年深圳地区腹泻患者沙门菌的感染特征和耐药性情况,为沙门菌感染的防控提供科学依据。方法 从深圳市3家哨点医院腹泻门诊收集患者粪便标本,进行沙门菌的分离鉴定、血清分型及药敏试验;对7家医院上送的住院病人分离的沙门菌进行血清分型和药敏试验。结果 4 847份门诊患者的粪便标本中,分离出192株沙门菌,检出率为4.0%。5-10月是沙门菌检出的高峰, 5岁以下儿童和6-17岁是感染的主要人群,检出率分别为6.2%和5.3%。192株沙门菌中鉴定出18种血清型,其中鼠伤寒沙门氏菌、鼠伤寒沙门氏菌变种和肠炎沙门氏菌是最常见的3种血清型,另有19株未能分型。77株住院病人分离的沙门菌中鉴定出20种血清型,其中肠炎沙门氏菌、鼠伤寒沙门氏菌变种、甲型副伤寒沙门氏菌占比分别为33.8%、13.0%和11.7%,另有3株未能分型。45株沙门菌对氨苄西林、环丙沙星和左旋氧氟沙星的耐药最为严重,自2015年开始出现对喹诺酮类药物的耐药和多重耐药菌株,10株鼠伤寒沙门氏菌中多重耐药率为50.0%。结论 深圳市腹泻患者的沙门菌感染以17岁以下儿童为主,5-10月份为感染的高峰期,沙门菌的血清型分散,其中肠炎沙门氏菌和鼠伤寒沙门氏菌、鼠伤寒沙门氏菌变种是主要的血清型,多重耐药自2015年开始日趋严重,临床上应合理规范用药并且加强耐药监测。     

贵州省2017-2018年非伤寒沙门菌临床分离株耐药及分子分型研究

目的 了解贵州省2017-2018年非伤寒沙门菌(NTS)的血清型分布、耐药情况与脉冲凝胶电泳(PFGE)分子分型特征。方法 对分离自贵州省临床病例的191株非伤寒沙门菌菌株进行生化鉴定、血清型分型,微量肉汤稀释法测定16种抗生素的最小抑菌浓度,PFGE进行分子分型分析。结果 191株非伤寒沙门菌分出18种血清型,鼠伤寒沙门菌(45.5%,87/191)和肠炎沙门菌(29.3%,56/191)为主要血清型。对所测抗生素产生耐药的菌株占96.8%(185/191),对磺胺异恶唑、链霉素、氨苄西林、四环素、多西环素耐药率较高,均超过60.0%。对头孢曲松和环丙沙星耐药率分别为7.9%(15/191)和13.1%(25/191)。多重耐药率为84.3%(161/191),共有69种耐药谱,主要耐药谱型为氨苄西林+链霉素+磺胺异恶唑+萘啶酸和氨苄西林+氯霉素+链霉素+磺胺异恶唑+四环素+多西环素+复方新诺明。87株鼠伤寒沙门菌共分为60种带型,优势型别为JPXX01.GZ0047(12.6%,11/87)。56株肠炎沙门菌共分为21种带型,优势型别为JEGX01.GZ0005(23.3%,13/56)。结论 贵州省NTS主要血清型为鼠伤寒沙门菌和肠炎沙门菌,多重耐药现象严重,PFGE带型总体呈多样性,部分带型与耐药表型有一定的关联性。     

福建省鼠伤寒沙门菌β-内酰胺耐药表型及ESBLs耐药基因分析

目的 调查福建省鼠伤寒沙门菌β-内酰胺耐药状况及其与ESBLs耐药基因之间的关系。方法 利用微量肉汤稀释法测定83 株鼠伤寒沙门菌对β-内酰胺类及ESBLs菌株其他18种药物的最小抑菌浓度(MIC)并计算耐药率;同时用PCR方法检测菌株ESBLs相关基因bla_TEM、bla_CTX-M、bla_OXA及bla_SHV的携带情况,并对bla_CTX-M阳性基因进行测序分型。结果 两类不同来源菌株均对氨苄西林和氨苄西林-舒巴坦的耐药率较高,腹泻患者来源株对第三、四代头孢有不同程度的耐药。腹泻患者来源株中检出10株ESBLs阳性菌株,检出率16.39%(10/61),该类菌株全部为多重耐药。腹泻患者来源株bla_TEM、bla_CTX-M和bla_OXA基因检出率分别为55.74%(34/61)、16.39%(10/61)和19.67%(12/61);健康人员来源株bla_TEM和bla_OXA基因检出率分别为22.73%(5/22)和18.18%(4/22),未检出bla_CTX-M基因,两类菌株均未检出bla_SHV基因。10株bla_CTX-M基因阳性株测序表明bla_CTX-M-14基因型4株、bla_CTX-M-15和bla_CTX-M-55基因型各3株。相关性分析表明bla_TEM基因与氨苄西林耐药表型具有较好的一致性(P<0.001, Ka=0.546),bla_CTX-M基因与头孢噻肟和头孢吡肟耐药表型高度一致(P<0.001, Ka=1.000),与头孢他定(P<0.001, Ka=0.626)和氨曲南(P<0.001, Ka=0.668)一致性较好。结论 福建省鼠伤寒沙门菌对头孢菌素及ESBLs耐药主要由bla_CTX-M基因介导且ESBLs菌株多重耐药现象严重。     

沙门菌果蝇感染致死模型构建及其评价

目的 为了比较不同沙门菌对果蝇致死毒力,建立果蝇沙门菌肠道感染模型,并进行模型评价。方法 将鼠伤寒沙门菌SL1344、14028S和肠炎沙门菌C50041及其突变株C50041ΔspiC,以OD₆₀₀为100的高浓度菌液通过饲喂法和针刺法,分别感染30只CS型果蝇和yw型果蝇,每隔3 h观察活果蝇数,计算存活率,分析沙门菌毒力。结果 肠炎沙门菌C50041和C50041ΔspiC饲喂果蝇,120小时后CS型果蝇存活率0%,yw型果蝇的存活率低于20%,而针刺法感染CS型果蝇和yw型果蝇存活率则高于80%;鼠伤寒沙门菌饲喂法感染CS型果蝇和yw型果蝇,其存活率均高于90%。针刺法存活率均高于60%。比较分析显示,鼠伤寒沙门菌肠道感染耐受和肠炎沙门菌肠道感染敏感,存在明显的差异;肠炎沙门菌对果蝇肠道感染模式的毒力明显高于非肠道感染模式,不同果蝇品系之间则无明显的差异。结论 本研究中,果蝇沙门菌肠道感染模型被成功建立,并能够评价不同沙门菌的毒力,其中肠炎沙门菌C50041果蝇肠道感染呈高度敏感,为后续肠炎沙门菌功能基因鉴定研究奠定基础,便于深入研究沙门菌致病机理。     

新生儿科分离的产ESBL肺炎克雷伯菌基因分型研究

目的分析新生儿科分离的产ESBL肺炎克雷伯菌基因分型。方法选取本院新生儿科重症监护室产ESBL肺炎克雷伯菌感染患儿52例,分离菌株,行细菌DNA提取和PCR扩增检测,分析产ESBL肺炎克雷伯菌的基因分型。结果 52株病菌中,单基因型23株、2个以上基因型29株。TEM型13株、SHV型20株、CTX-M型40株、GES型7株、PER型3株。ESBL为阳性菌株36株,ESBL为阴性菌株16株,产ESBL肺炎克雷伯菌的阳性率为69.2%。结论新生儿科广泛存在产ESBL肺炎克雷伯菌,其中CTX-M型居多。细菌DNA提取和PCR扩增检测是产ESBL肺炎克雷伯菌基因分型的有效方法。     

High prevalence of blaCTX-M in Enterobacteriaceae isolates from the Kingdom of Bahrain

ObjectiveTo determine the molecular epidemiology of extended-spectrum β-lactamase (ESBL) by testing a cohort of clinical ESBL-producing bacterial isolates that were isolated in the Kingdom of Bahrain.MethodsESBL producing Enterobacteriaceae isolates (based on phenotypic tests) were collected from Microbiology Laboratory of the Salmaniya Medical Complex, Bahrain between January-June 2006. Antibiotic susceptibility to a panel of antibiotics was performed and bla_CTX-M genes were detected by multiplex PCR.ResultsA total of 230 isolates (Escherichia coli, n=180; Klebsiella pneumoniae, n=50) were studied, 98% were CTX-M type. For Escherichia coli isolates, 65 (36.1%) harbored CTXM+TEM combination and 68 (37.8%) had CTX-M alone. In contrast, for Klebsiella pneumoniae isolates only 5 (10.0%) harbored the CTX-M combination, and none had CTX-M only. The bla_CTX-M gene was found predominantly in urine isolates (n=145/230; 63.0%). Sensitivity to imipenem and nitrofurantoin was 100% and 60%, respectively. CTX-M carriage was associated with the resistance to fluoroquinolones, trimethoprim-sulfamethoxazole and aminoglycosides.ConclusionsOur study documentes high prevalence of CTX-M ESBL type among Escherichia coli and Klebsiella from the Kingdom of Bahrain. The apparent dissemination of CTX-M producers could represent a substantial barrier in the treatment of community-acquired infections. The use of extended-spectrum cephalosporins, quinolones, and aminoglycosides is compromised, leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.     

SHV-type extended-spectrum beta-lactamase (ESBL) are encoded in related plasmids from enterobacteria clinical isolates from Mexico

OBJECTIVE: In this work we report the molecular characterization of beta-lactam antibiotics resistance conferred by genes contained in plasmids from enterobacteria producing extended-spectrum beta-lactamases (ESBL). MATERIAL AND METHODS: Fourteen enterobacterial clinical isolates selected from a group of strains obtained from seven different hospitals in Mexico during 1990-1992 and 1996-1998 were analyzed at the Bacterial Resistance Laboratory (National Institute Public Health, Cuernavaca). Molecular characterization included PFGE, IEF of beta-lactamases, bacterial conjugation, PCR amplification and DNA sequencing, plasmid extraction and restriction. RESULTS: Isolates were genetically unrelated. ESBL identified were SHV-2 (5/14) and SHV-5 (9/14) type. Cephalosporin-resistance was transferable in 9 of 14 (64%) clinical isolates with only one conjugative plasmid, DNA finger printing showed a similar band pattern in plasmids. CONCLUSIONS: The dissemination of cephalosporin resistance was due to related plasmids carrying the ESBL genes.     

耐药嗜水气单胞菌毒力与六类抗菌药物耐药元件基因研究

目的 了解嗜水气单胞菌毒力基因与耐药基因的分布情况,为嗜水气单胞菌感染的治疗提供参考依据。方法 分离自2014年1月至2017年10月本院内科住院病人的10株嗜水气单胞菌;采用PCR法,对10株嗜水气单胞菌检测3种毒力基因与54种耐药基因,并对检测结果作样本聚类分析。结果 10株耐药嗜水气单胞菌3种重要的毒力基因检测结果,hlyA基因检出率为100.00%,aerA基因检出率为20.00%, rtxA基因无检出。10株耐药嗜水气单胞菌6种β-内酰胺酶基因, blaAQU与blaMOX基因表达AmpC型β-内酰胺酶,10株中有5株同时检出blaAQU与blaMOX基因,1株仅检出blaMOX基因, 6株AmpC酶三维试验均呈阳性。对10株耐药嗜水气单胞菌和1株敏感嗜水气单胞菌3种毒力基因与6类抗菌药物54种耐药元件基因检测结果作UPGMA法样本聚类分析, 10株耐药嗜水气单胞菌和1株敏感嗜水气单胞菌可分为A与B二个群。结论 10株耐药嗜水气单胞菌共检出β-内酰胺类、氨基糖苷类、喹诺酮类、磺胺类、氯霉素类等5类抗菌药物17种获得性耐药基因。7种可移动遗传元件标记基因,有5株检出1~3种可移动遗传元件标记基因。10株耐药嗜水气单胞菌3种毒力基因与54种耐药元件基因同步检测显示,每株至少检出1种毒力基因和2种耐药基因,嗜水气单胞菌对抗菌药物的耐药率上升必须严密监测。     

同时产PER-1型和TEM-1型β内酰胺酶铜绿假单胞菌的检出

目的　分析多重耐药铜绿假单胞菌临床株 (编号 0 10 7)对 β内酰胺类抗生素耐药情况及其原因。 方法　用改良三维试验分析 0 10 7株产生的 β内酰胺酶表型 ,以碱裂解法提取质粒 ,用聚合酶链反应 (PCR)方法扩增质粒的酶基因型别 ,并对阳性产物测序。结果　 0 10 7号铜绿假单胞菌临床株产生超广谱 β内酰胺酶 (ESBLs) ,携有blaPER - 1基因 ,同时还有blaTEM - 1型基因。结论　 0 10 7号菌株耐 β内酰胺类抗生素耐药的可能原因是产生PER - 1型的ESBLs和TEM - 1型的广谱酶。     

Surveillance of nalidixic acid-resistant and extended-spectrum beta-lactamase-producing Salmonella spp. isolated from human feces

Nalidixic acid (NA)-resistant and extended-spectrum beta-lactamase (ESBL)-producing Salmonella sp. isolates from human specimens are associated with clinical failure or delayed response in subjects treated with fluoroquinolone or third-generation cephalosporins. We studied drug susceptibility in 604 Salmonella enterica isolates from human feces in 2007. Of these, 39 (6.5%) were resistat to NA. Of these, 46% were resistant to two or more drugs and 2% susceptible to NA were resistant to multiple drugs (p < 0.001). Three ESBL-producing Salmonella sp. isolated were of the CTX-M family gene type. One strain of plasmid-mediated AmpC beta-lactamase belonged to the CMY-2 family gene type. Our results thus showed that NA-resistant isolates were resistant to antimicrobial agents and confirmed the presence of a small number of isolates producing ESBL and AmpC beta-lactamase.     

Detection and molecular genetics of extended-spectrum beta-lactamases among cefuroxime-resistant Escherichia coli and Klebsiella spp. isolates from Finland, 2002-2004

Extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella spp. isolates are spreading and becoming an increasing problem concerning treatment, diagnostics and hospital hygiene. We wanted to discover which genotypes are occurring in Finland and to assess the CLSI screening method. The isolates were collected from 26 laboratories during a 3-y period from 2002 to 2004. We studied the zone diameters by disk diffusion according to CLSI recommendations. ESBL genes were detected by PCR and the TEM and SHV genes were sequenced traditionally, while the CTX-M isolates were analysed with pyrosequencing. Of the 402 isolates included in the study, 269 (67%) were confirmed to be ESBL producers according to the CLSI criteria. The CTX-M genes were the most prevalent, especially the combination of a CTX-M-1-group and a TEM-1 gene. In our material there were few isolates that had an ESBL gene but were negative in the CLSI ESBL confirmatory test. During recent y especially the CTX-M producing isolates have increased in Europe and now they are also found in Finland with increasing prevalence.     

铜绿假单胞菌耐药性分析及分子流行病学研究简

目的 分析铜绿假单胞菌（PA）耐药现状及耐药基因情况.方法收集2009~2012年临床分离的PA 305株.K-B法进行药敏试验,并检出产ESBLs菌株及耐碳青霉烯的PA,用聚合酶链反应（PCR）对产ESBLs菌株进行TEM、SHV、CTX-M基因检测,对耐碳青霉烯PA进行VIM、IPM、OXA-23基因检测.结果 3年中PA对亚胺培南、美罗培南、头孢他啶、左氧的耐药率呈上升趋势,氨曲南、阿米卡星的耐药率呈下降趋势,305株PA中共检出48株产ESBLs,57株耐碳青霉烯.PCR检测出5株PA含TEM基因,2株含SHV基因.CTX-M、VIM、IPM、OXA-23基因检测均为阴性.结论 产ESBLs是我院耐药PA的重要原因,耐碳青霉烯的PA不含VIM、IPM、OXA-23基因.     

Diversity of extended-spectrum β-lactamase-producing Enterobacteriaceae on hospital admission

Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become prevalent in both the hospital and the community. We describe the epidemiology of ESBL-producing isolates and patient characteristics at hospital admission. Data on clinical properties, medical history, previous hospitalizations, and previous antibiotic treatments were collected. ESBL genes (bla(CTX-M), bla(TEM), and bla(SHV)) were identified by polymerase chain reaction. One hundred and sixteen patients carried 122 ESBL-producing Enterobacteriaceae: 79 Escherichia coli, 26 Klebsiella pneumoniae, 16 Enterobacter spp., and 1 Citrobacter koseri. ESBL-producing E. coli were associated with admission from home (odds ratio (OR) 3.04, p = 0.02) and a history of recent urinary tract infection (OR 3.38, p = 0.04), and exhibited a lower rate of antimicrobial resistance to aminoglycosides (p ≤ 0.005) and co-trimoxazole (p = 0.003), whereas other ESBL-producing Enterobacteriaceae tended to be associated with a recent surgery (OR 0.42, p = 0.057). Although the CTX-M enzymes were more frequently found in E. coli (76%), they were also identified in other Enterobacteriaceae (45%), suggesting penetration of CTX-M-type enzymes into both community- and hospital-acquired enterobacterial species.     

广西宋内志贺菌药敏特性及ESBLs基因检测分析

目的了解广西地区宋内志贺菌的药敏特性及携带超广谱β-内酰胺酶(ESBLs)基因与型别特征,为临床合理用药和控制耐药性的传播提供科学依据。方法采用微量肉汤稀释法对宋内志贺菌分离株进行药物敏感试验;采用PCR方法和毛细管电泳方法检测菌株携带相关ESBLs基因;采用近邻相接法构建系统进化树,分析菌株CTX-M型基因型别;对菌株携带ESBLs基因与特定抗菌药物耐药性的关系进行统计学分析。结果90株宋内志贺菌对环丙沙星敏感率为86.67%,无耐药现象;头孢曲松耐药率为96.67%,阿奇霉素耐药率为96.67%,多重耐药率为98.89%。90株宋内志贺菌中50株检出blaCTX-M-9 group基因,检出率为55.56%,经系统发育分析均为CTX-M-14亚型;1株检出blaTEM基因,检出率为1.11%;未检出blaCTX-M-1 group,blaCTX-M-2 group,blaCTX-M-8 group,blaCTX-M-25 group和blaOXA,blaSHV,blaNDM,blaVIM等β-内酰胺酶基因。blaCTX-M-14基因阳性菌株与blaCTX-M-14基因阴性菌株对头孢噻肟的耐药率差异无统计学意义(χ²=0.000,P>0.05);携带blaTEM基因的菌株对头孢他啶不耐药。结论广西地区的宋内志贺菌对主要治疗药物头孢曲松高度耐药,且多重耐药现象严重;菌株普遍携带ESBLs基因,主要为CTX-M-14亚型;携带单一型别的ESBLs基因与菌株对特定β-内酰胺类抗菌药物耐药无明显关联。