山西吕梁市产ESBL大肠埃希菌基因型和耐药性分析

Analysis on genotypes and drug resistance of Escherichia coli producing extended-spectrum β-lactamase in Lüliang city,Shanxi province

目的探讨吕梁地区产超广谱β-内酰胺酶(ESBL)大肠埃希菌的基因型及其对常用抗菌药物的耐药性,为临床合理用药提供科学依据。方法采用半自动细菌鉴定和药敏分析仪对临床送检的各类标本进行细菌鉴定和药敏试验,按照CLSI推荐的双纸片扩散法和表型确证试验检测产ESBL大肠埃希菌,对产ESBL大肠埃希菌通过PCR法鉴定ESBL基因型。结果临床分离的87株大肠埃希菌中检出产ESBL大肠埃希菌42株(48.3%),PCR结果显示SHV、TEM、CTX基因型分别有1株,4株和10株,27株细菌携带2种以上基因型。药敏结果显示产ESBL大肠埃希菌对青霉素类和头孢菌素类(头孢吡肟除外)的耐药率在95%以上,对环丙沙星、复方新诺明、左氧氟沙星、妥布霉素、庆大霉素、头孢吡肟的耐药率较高(59.52%-92.86%),对头孢西丁和阿米卡星的耐药率较低(<19.05%),对美洛培南和亚胺培南则全部敏感。结论吕梁地区产ESBL大肠埃希菌以多基因型为主,产ESBL大肠埃希菌对16种常用抗菌药物的耐药情况明显高于非产ESBL大肠埃希菌。

Objective To explore the genotype of broad-spectrum β-lactamase（ESBL）-producing Escherichia coli（E.coli） and its resistance to antibiotics commonly used in Lüliang,and to provide a scientific basis for rational use of drugs in clinical practice.Methods The bacterial identification and drug sensitive test of clinical specimens were completed by semi-automatic bacterial identification and susceptibility analyzer.ESBL-producing E.coli was detected by the double dish diffusion method and phenotypic confirmatory test recommended by CLSI,and the ESBL genotype was verified by PCR.Results Of 87 strains of E.coli isolated from clinical samples,42 strains produced ESBL（48.3%）.PCR results showed that there was 1 strain,4 strains and 10 strains of E.coli in the genotypes SHV,TEM and CTX,respectively,and 27 strains carried more than two genotypes.Drug sensitivity results showed that the drug resistance rates of ESBL-producing E.coli to penicillin and cephalosporin（except cefepime） were both more than 95%,the drug resistance rates to ciprofloxacin,compound sulfamethoxazole,levofloxacin,tobramycin,gentamicin and cefepime were high（59.52%-92.86%）,but the drug resistance rates to cefoxitin and amikacin were less than 19.05%,and all E.coli strains were sensitive to meropenem and imipenem.Conclusion The genotype of ESBL-producing E.coli is mainly multi-genotype in Lüliang,and the resistance rates of ESBL-producing E.coli to 16 kinds of antibiotics commonly used is significantly higher than that of non-ESBL-producing E.coli.