肿瘤患者医院感染产ESBLS大肠埃希菌调查及基因分析

Investigation and gene analysis of ESBLS producing-Escherichia coli in cancer patients with nosocomial infection

目的探讨肿瘤患者医院感染产超广谱β-内酰胺酶(extended spectrum beta-lactamase,ESBLs)大肠埃希菌的临床特点,并分析其基因型特征。方法对2014年3月~2016年10月我院肿瘤患者498株临床标本中分离出的338株产ESBLs大肠埃希菌的临床分布进行分析,并比较产与非产ESBLs菌株对19种抗菌药物的耐药率,同时随机抽取338株中的60株应用聚合酶链反应(polymerase chain reaction,PCR)分别扩增ESBLs基因(TEM、CTX-M和SHV)型别。结果 498株大肠埃希菌中产ESBLs 338株(67.87%),标本类型以尿液标本为多(101株,29.88%),临床科室分布中妇瘤科最多(94株,27.81%)。产与非产ESBLs大肠埃希菌对亚胺培南及美罗培南耐敏感性高(耐药率为零),而产ESBLs大肠埃希菌的耐药率大多数均高于非产ESBLs大肠埃希菌,差异均有统计学意义(P<0.05)。PCR扩增后基因测序显示,55株为TEM(91.67%),42株为CTX-M1(70.00%),42株为CTX-M13(70.00%),24株为SHV(40.00%),其中携带2种或2种以上耐药基因的有53株(88.33%)。结论本研究肿瘤患者医院感染产ESBLs大肠埃希菌主要标本以尿液标本为主,重点分布在妇瘤科;基因型以TEM、CTX-M1、CTX-M13型为主,并呈现多重耐药趋势。

Objective To analyze the clinical features and genotypic characteristics of ESBLS producing-Escherichia coli in cancer patients with nosocomial infection. Methods A total of 338 strains in 498 from the clinical specimens of ESBLs-producing E.coli isolated from clinical specimens of patients with malignant tumor in our hospital were collected from March 2014 to October 2016 and analyzed and compared with the production producing ESBLs strains of 19 kinds of antimicrobial drug resistance,among which 60 of the 338 strains were randomly selected and amplified via polymerase chain reaction （PCR） for common β-lactamase gene （TEM,CTX-M and SHV） of ESBLs-producing E.coli. Results Among the 498 strains of E.coli,338 strains were capable of producing ESBLs,contributing to 67.87% of total.E.coli was most commonly detected in urine,as found in 101 strains,taking up 29.88%;E.coli was most commonly detected in specimen from department of gynecological oncology,as found in 94 strains,taking up 27.81%;The high sensitivity （resistance rate） of ESBLs and ESBLs was high （zero tolerance rate）.The resistance rate of ESBLs escherichia coli was higher than that of ESBLs.the antibacterial of two drugs had statistical significant difference （ P 〈0.05）.PCR amplification showed that among 60 strains producing ESBLs-producing Escherichia coli,55 strains expressed TEM （91.67 %）,42 strains expressed CTX-M1 （70.00 %）,42 strains expressed CTX-M13 （70.00 %）,24 strains expressed SHV （40.00 %）,of which 53 strains （88.33 %） carried more than two resistance genes. Conclusion The main specimens of ESBLs-producing Escherichia coli from patients with cancer in our hospital were mainly urine specimens,and mainly distributed in departments of gynecological oncology,whose primary genotypes were TEM,CTX-M1 and CTX-M13 and present the trend of multiple drug resistance.