摘要
目的了解贵阳地区医院内检出的大肠埃希菌产超广谱β-内酰胺酶（ESBLs）菌株的耐药性及基因型,为指导临床合理用药提供依据。方法由贵州医科大学附属白云医院ATB系统完成菌株鉴定及药敏试验检测,采用纸片扩散法进行ESBLs表型确证试验,采用碱裂解法提取产ESBLs菌的质粒DNA,采用聚合酶链反应扩增TEM型、SHV型、CTX-M-1组和CTX-M-9组基因。结果产ESBLs大肠埃希菌阳性率为66.7%（279/418）;对阿米卡星耐药率为4.3%;对青霉素类,头孢菌素第1、2代药物耐药率均为100.0%;庆大霉素、妥布霉素、喹诺酮类、磺胺类药物耐药率在60.6%～84.9%;对亚胺培南和美罗培南仍保持较高的敏感度。116株产ESBLs大肠埃希菌基因型有113株（97.4%）为CTX-M型,其中CTX-M-9亚型68株（58.6%）,CTX-M-1亚型67株（57.8%）;TEM型有86株（74.1%）;未检出SHV型。结论产ESBLs阳性的大肠埃希菌的耐药率明显高于产ESBLs阴性的大肠埃希菌,且具有多重耐药性。贵州医科大学附属白云医院产ESBLs大肠埃希菌的基因型以CTX-M型为主;碳青霉烯类为最敏感的药物,但本研究中发现亚胺培南耐药菌株,需引起临床重视。
Objective To investigate the genotype and antimicrobial resistance of ESBLs-producing Escherichia coli（E.coli）in this hospital to provide basis of reasonable drug usage.Methods ATB system was used to identify strains and drug sensitivity test.ESBLs-producing E.coli isolates were screened by phenotypic confirmatory test.The plasmid DNAs of ESBLs-producing strains were extracted by alkaline lysis.Nucleotide sequences of TEM,SHV,CTX-M-1 and CTX-M-9 genes in the ESBL-producing strains isolated were amplified by PCR.Results The positive rate of ESBLs-producing was 66.7% in 418 strains of E.coli（279/418）;the drug resistance rates to amikacin was 4.3%;to penicillin,the antibiotic resistance of first and two generation cephalosporins were100.0%;to gentamicin,tobramycin,quinolones and sulfonamides,the antibiotic resistance varied from 60.6%to 84.9%;still maintain a high sensitivity to imipenem and meropenem.There were 113 strains of CTX-M type（97.4%）in 116 strains of ESBLs-producing E.coli genotype,including 68 strains in CTX-M-9 type（58.6%）,67 strains in CTX-M-1 type（57.8%）,86 strains in TEM type（74.1%）,SHV was not detected.Conclusion Antimicrobial resistances of E.coli might be more sensitive ESBLs-producing than non ESBLs-producing E.coli,and with multi drug resistance.The predominant genotype of ESBLs-producing strains is CTXM.ESBLs-producing E.coli remains susceptible to carbapenems.Moreover,the imipenem-resistant strains are detected in the study,which is worth heeding.
出处
《检验医学与临床》
CAS
2016年第12期1638-1640,共3页
Laboratory Medicine and Clinic
