大肠埃希菌产质粒介导AmpC酶基因在中国分布的Meta分析

Distribution of plasmid mediated AmpC genes of β-lactamase-producing Escherichia coli in China:A meta analysis

目的系统评价大肠埃希菌产质粒介导AmpC酶基因在中国的分布情况。方法检索四个中文数据库、EMbase、PubMed及外文期刊数据库,检索时间为建库至2015年5月,由2名独立的研究者严格按照纳入和排除标准筛选文献、提取相关数据,对筛选到的大肠埃希菌ESBLs基因的研究文献,采用Stata 12.1软件进行单组率的Meta分析,分析内容包括大肠埃希菌质粒介导AmpC酶各类基因的检出率和不同地区的分布差异。结果共纳入35篇中文文献和4篇外文文献,采用随机效应模式进行数据分析,合并结果显示:(1)中国大肠埃希菌质粒介导AmpC酶基因的阳性率为5.0%(95%CI:4.0%-7.0%)、2005-2008年大肠埃希菌质粒介导AmpC酶基因的阳性率为5.0%(95%CI:3.0%-7.0%)、2009-2013年大肠埃希菌质粒介导AmpC酶基因的阳性率为6.0%(95%CI:4.0%-8.0%),两个时间段AmpC酶基因阳性率的差异具有统计学意义(P<0.05);(2)DHA型引物扩增基因的检出率为43.0%(95%CI:28.0%-59.0%)、CIT型引物扩增基因的检出率为52.0%(95%CI:37.0%-66.0%)、EBC型引物扩增基因的检出率为23.0%(95%CI:10.0%-37.0%);(3)北方地区大肠埃希菌质粒介导AmpC酶基因的阳性率为8.0%(95%CI:5.0%-11.0%)、东南地区大肠埃希菌质粒介导AmpC酶基因的阳性率为5.0%(95%CI:1.0%-9.0%)、中西部地区大肠埃希菌质粒介导AmpC酶基因的阳性率为6.0%(95%CI:2.0%-10.0%)、长江三角洲地区大肠埃希菌质粒介导AmpC酶基因的阳性率为7.0%(95%CI:4.0%-9.0%),经χ2检验,四个地区质粒介导AmpC酶基因的阳性率差异具有统计学意义(P<0.05)。结论大肠埃希菌质粒介导AmpC酶基因在中国以CIT型引物扩增基因的检出率最高,且主要为CMY-2基因;2009-2013年时段AmpC酶基因阳性率高于2005-2008年时段,差异具有统计学意义(P<0.05);中国四个地区大肠埃希菌质粒介导AmpC酶基因的阳性率差异具有统计学意义(P<0.05)。

Objective To analyze the distribution of plasmid-mediated AmpC genes of beta-lactamase producing Escherichia coli in China.Methods Retrieving four Chinese database,EMbase,PubMed and foreign periodicals database,retrieval time for the database until May 2015,by two independent researchers strictly according to the inclusion and exclusion criteria selected studies and extracted relevant data of screening of the ESBLs genes in E.coli,the research literature by Stata 12.1single group rate of meta analysis,analysis includes the detection rate of all kinds of plasmid mediated AmpC enzyme gene of E.coli and the distribution of different regions.Results A total of 35 Chinese and 4foreign literatures were included,and the data were analyzed by random effects model,merge result display：（1）the E.coli plasmid mediated by the positive rate of AmpC enzyme gene was 5.0%（95%CI：4.0%-7.0%）.The positive rate of plasmid mediated AmpC enzyme gene in E.coli was 5.0%in 2005-2008（95%CI：3.0%-7.0%）.The positive rate of plasmid mediated AmpC enzyme gene in E.coli was 6.0% in 2009-2013（95%CI：4.0%-8.0%）,the differences in two time periods of AmpC enzyme gene positive rate had statistical significance（P0.05）;（2）The detection rate of DHA primer amplification gene was 43.0%（95%CI：28.0%-59.0%）.The detection rate of CIT primer amplification gene was 52.0%（95%CI：37.0%-66.0%）.The detection rate of EBC primer amplification gene was 23.0%（95%CI：10.0%-37.0%）;（3）The positive rate of plasmid mediated AmpC enzyme gene of E.coli was 8.0%（95%CI：5.0%-11.0%）in the north of China.The positive rate of plasmid mediated AmpC enzyme gene in E.coli was 5.0%（95%CI：1.0%-9.0%）in the southeast of China.The positive rate of plasmid mediated AmpC enzyme gene in E.coli was 6.0%（95%CI：2.0%-10.0%）in the central and western regions.The positive rate of plasmid mediated AmpC enzyme gene in E.coli was 7.0%（95%CI：4.0%-9.0%）in the Yangtze River Delta.Byχ2 test,there were significant differences in the positive rates of plasmid mediated AmpC enzyme gene in four regions（P0.05）.Conclusion The plasmid mediated AmpC enzyme gene in E.coli is the highest detection rate of CIT gene amplification in China,and mainly for the CMY-2gene;The positive rate of AmpC enzyme gene in2009-2013 is higher than that in 2005-2008,the difference is statistically significant（P0.05）;There is significant difference in the positive rate of plasmid mediated AmpC enzyme gene in four regions of China（P0.05）.