某医院住院儿童产超广谱β-内酰胺酶大肠埃希菌分布及耐药性分析-现代医学

某医院住院儿童产超广谱β-内酰胺酶大肠埃希菌分布及耐药性分析

单位：滨海县人民医院儿科, 江苏盐城 224500

分类号：R197.323.4;R72

出版年·卷·期（页码）：2018·46·第十一期（1252-1255）

摘要：

目的：了解住院儿童产超广谱β-内酰胺酶（extended-spectrum β-lactamases，ESBLs）大肠埃希菌（Escherichia coli，ECO）分布、耐药及耐药基因分布情况，为临床治疗感染大肠埃希菌儿童提供依据。方法：采用VITEK-32微生物分析系统对98株大肠埃希菌进行鉴定，采取纸片扩散法进行ESBLs表型检测，对51株产ESBLs大肠埃希菌用K-B纸片法检测菌株的药敏情况，采用聚合酶链反应技术（PCR）检测菌株的耐药基因。结果：（1）共分离大肠埃希菌98株，以婴幼儿期检出最高；标本来源以深部痰为主，占63.2%，其次是咽拭子和尿液，分别占10.2%和8.1%。（2）ESBLs的检出率为52.0%，产酶株对氨苄西林、头孢唑啉和头孢噻肟耐药率达100%，未检出亚胺培南耐药株。（3）耐药基因intl1携带率为88.2%，ampC携带率为78.4%，tem携带率为49.0%，acc、DHA1、NDM、fox均未检出。携带2种和3种耐药基因的菌株分别占82.4%和37.3%。结论：感染大肠埃希菌儿童以婴幼儿为主；大肠埃希菌产ESBLs率高，耐药形势严峻，耐药模式复杂；加强对大肠埃希菌耐药的监控具有非常重要的理论和实际意义。

Objective:To study distribution, drug resistance and the distribution of genotypes resistant of Escherichia coli producing extended spectrum β- lactamase so as to provide reference for the diagnosis and treatment of children with infection. Methods:The VITEK-32 was used to identify 98 strains of Escherichia coli and ESBLs were detected with disc diffusion test. The antimicrobial susceptibility of 51 strains of Escherichia coli producing ESBLs was determined using strain K-B method and resistance genes were detected by polymerase chain reaction (PCR). Results:(1) A total of 98 strains of Escherichia coli were isolated, the highest rate was detected in infantile period. The main source of the specimen was the deep phlegm, accounting for 63.2%, followed by swabs and urine, accounting for 10.2% and 8.1% respectively. (2) The detection rate of ESBLs was 52.0%. The resistant rate of ampicillin, cefazolin and cefotaxime was as high as 100%, and no imipenem resistant strain was detected. (3) Drug resistance gene detection showed that intl1 carrier rate was 88.2%, ampC carrier rate was 78.4%, TEM carrier rate was 49.0%, acc, DHA1, NDM, fox were not detected. Strains carrying 2 and 3 resistance genes accounted for 82.4% and 37.3% respectively. Conclusion:The majority of children infected with Escherichia coli are mainly infants. The rate of producing ESBLs is high, the situation of drug resistance is severe, and the drug resistance pattern is complex. Strengthening drug resistance monitoring is of great theoretical and practical significance.

参考文献：

[1] KOINGSTEIN M,LEENEN M A,MUGHINI-GRAS L,et al.Prevalence and risk factors for colonization with extended-spectrum cephalosporin-resistant Escherichia coli in children attending daycare centers:a cohort study in the netherlands[J].Pediatric Infect Dis Soc,2015,4(4):e93-99.
[2] Clinical and laboratory standads institute.Performance standards for antimicrobial susceptibility testing[S].Fifteenth Informational Supplement,2014:M100-S24.
[3] 方晶,薛博瑜,方南元.肠道细菌与肠黏膜机械屏障损伤关系的研究进展[J].东南大学学报(医学版),2018,37(2):330-334.
[4] PARK M J,KIM T K,SONG W,et al.An increase in the clinical isolation of acquired ampC β-lactamase-producing klebsiella pneumoniae in Korea from 2007 to 2010[J].Ann Lab Med,2013,33(5):353-355.
[5] 邱小梅,刘东才,冯桂玲,等.某三甲医院儿童产ESBLs大肠埃希菌临床分布及耐药性分析[J].药物流行病学杂志,2016,25(11):711-715.
[6] 陆芸芸,罗蓉,符州.儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J].中国当代儿科杂志,2017,19(9):983-988.
[7] 王丽萍,邵春红,范会,等.某院2013-2016年儿童呼吸道感染病原菌分布及耐药性分析[J].检验医学与临床,2018,15(11):1537-1541.
[8] 谷光洁,景春梅.重庆地区儿童感染患者11039株大肠埃希菌的临床分布及耐药性[J].中国微生态学杂志,2017,29(6):696-699,703.
[9] YAYAN J,GHEBREMEDHIN B,RASCHE K.No development of imipenem resistance in pneumonia caused by Escherichia coli[J].Medicine,2015,94(25):e1020.
[10] 何丽华,郭建,周爱萍,等.上海某新建医院2016年细菌耐药性监测分析[J].中华医院感染学杂志,2018,28(12):1774-1778.
[11] DEUTSCH R F,ROSS J W,NAILOR M D.Carbapenem-resistant enterobacteriaceae:a case series of infections at hartford hospital[J].Conn Med,2015,79(5):269-275.

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