北京解放军总医院肠致病性大肠埃希菌的流行及耐药现状

Prevalence and drug resistance of enteropathogenic Escherichia coli in People's Liberation Army General Hospital in Beijing

目的了解北京解放军总医院临床腹泻标本中分离的肠致病性大肠埃希菌(enteropathogenic Escherichia.coli,EPEC)的分布和耐药情况,为临床治疗提供重要依据。方法采用Vitek MS质谱仪或Vitek 2compact GN进行细菌鉴定,并用肠致病性大肠埃希菌诊断血清进行血清型凝集,药敏实验采用纸片扩散法(K-B法)或Vitek 2 compact全自动细菌鉴定药敏仪,按CLSI2016-M100的标准进行药敏结果分析。结果 2008~2016年解放军总医院自临床腹泻标本分离到EPEC菌株82株,检出率为2.10%;EPEC的病例主要来自门急诊患者(28.05%),各年龄段均有检出。EPEC的血清型主要是O86:K61(B7)17株(20.73%),未检出O11:K55(B4)、O126:K71(B16)、O119:K69(B14)、O114:K90(B)血清型。EPEC对哌拉西林、氨苄西林-舒巴坦、头孢噻肟耐药比较严重,耐药率在70.00%左右;未检出耐碳青霉烯类抗生素的EPEC,对哌拉西林/他唑巴坦敏感率达到97.56%。结论 EPEC是引起腹泻病的一种重要致病菌,血清型较分散,耐药较严重,临床抗生素的选择应以药物敏感性试验为依据,哌拉西林/他唑巴坦可作为EPEC的经验用药选择。

Objective To investigate the distribution and drug resistance of enteropathogenic Escherichia coli （EPEC） isolated from diarrhea specimens in People＇s Liberation Army （PLA） General Hospital in Beijing,so as to provide an important basis for clinical treatment.Methods The bacteria was identified by Vitek mass spectrometer or Vitek 2 compact GN,and the serum type was detected by EPEC agglutination serum.The drug sensitivity test was carried out with the method of disc diffusion （K-B） or Vitek 2 compact.Susceptibility test and results were carried out and analyzed according to CLSI 2016-M 100 standard.Results A total of 82 clinical isolates of EPEC were isolated in 2008～2016,and the detection rate was 2.10%.EPEC cases were mainly from emergency patients （28.05%）.EPEC was detected in all age groups.The serotype of EPEC was mainly O86∶K61 （B7） （17strain,20.73%）.These serotypes,such as O11∶K55 （B4）,O126∶K71 （B16）,O119∶K69 （B14） and O114∶K90 （B） were not detected.The drug resistance of EPEC to piperacillin,ampicillin/sulbactam,and cefotaxime was serious,and the drug resistant rates were about 70%.The sensitivity of EPEC to carbapenems was 100%,which to piperacillin/tazobactam was almost 97.56%.Conclusion EPEC is an important pathogen causing diarrhea.The serotype of EPEC is dispersed and the drug resistance is serious.The choice of antibiotics should be based on drug sensitivity test.Piperacillin/tazobactam can be a good choice to be used as empirical treatment for EPEC.