社区和医院获得性尿道致病性大肠埃希菌耐药性分析

Drug resistance of community and hospital acquired uropathogenic Escherichia coli

目的了解浙江省社区和医院获得性尿道致病性大肠埃希菌的耐药现状及产超广谱β-内酰胺酶(ESBLs)菌株基因型,为临床合理用药提供科学依据。方法对2014年1月至2014年12月浙江省社区和医院获得性尿道致病性大肠埃希菌耐药情况进行分析,并随机各抽取20株菌株进行CTX-M基因型检测。结果社区和医院获得性大肠埃希菌共收集到93株和992株,产ESBLs菌株的阳性率分别为47.7%和68.5%,差异有统计学意义(P<0.05);社区获得性菌株CTX-M基因检出率为30.0%(6/20),其中又以CTX-M-9为主(4/6)。医院获得性菌株CTX-M基因检出率50.0%(10/20),其中CTX-M-9占7/10。医院获得性菌株对头孢呋辛、头孢唑啉、头孢曲松、环丙沙星、左旋氧氟沙星、甲氧苄氨嘧啶/磺胺甲恶唑、呋喃妥因和阿米卡星的敏感率明显低于社区获得性菌株(P<0.05)。结论浙江省医院获得性尿道致病性大肠埃希菌对部分抗菌药物的耐药率明显高于社区获得性菌株,ESBLs基因以CTX-M-9为主。

Objective To understand the drug resistance and ESBLs genotypes of community-and hospital-acquired uropathogenic Escherichia coli,and provide scientific evidences for clinical rational drug use.Methods The drug resistance of community-and hospital-acquired uropathgenic Escherichia.coli from Zhejiang province was analyzed.20 strains of the pathogen were randomly selected for CTX-M genotype detection.Results 93 strains of community-acquired and 992 strains of hospital-acquired uropathgenic Escherichia.Coli were collected,among which the positivity rates of ESBLs were 47.7% and 68.5% respectively;the difference was statistically significant（P〈0.05）.CTX-M gene was detected in 30.0%（6/20）of the community-acquired strains,with CTX-M-9being predominant（4/6）,and in 50.0%（10/20）of the hospital-acquired strains,with CTX-M-9accounting for 7/10.The sensitivity rates of hospital-acquired strains to Cefuroxime,Cefazolin,Ceftriaxone,Ciprofloxacin,Levofloxacin,Trimethoprim/Sulfamethoxazole,Nitrofurantoin and Amikacin were significantly lower than those of community-acquired strains（P〈0.05）.Conclusion The drug resistance rates of hospital-acquired uropathogenic Escherichia.coli in Zhejiang province to many antimicrobial agents were significantly higher than those of community-acquired strains;the predominant ESBLs gene was CTX-M-9.