成人社区获得性尿路感染大肠埃希菌耐药性分析

The drug resistance of Escherichia coli in adult community acquired urinary tract infection

目的了解成人社区获得性尿路感染大肠埃希菌的耐药性,为社区获得性尿路感染抗生素使用策略提供依据。方法收集社区获得性尿路感染患者中分离的大肠埃希菌,进行药物敏感性测试,采用PCR、测序方法确认其ESBL主要基因型,对ESBL阳性菌株进行MLST分型。结果共收集98株社区获得性尿路感染大肠埃希菌,其中检出产ESBL大肠埃希菌34株,阳性率为34.7%。药敏结果提示其对氨苄西林耐药率最高为72.4%,其次为头孢唑啉50%、环丙沙星43.9%、复方新诺明43.9%、左旋氧氟沙星39.8%、氨苄西林/舒巴坦34.4%、头孢曲松32.7%、庆大霉素30.6%,对氨曲南20.4%,头孢他啶11.5%,头孢吡肟7.1%,妥布霉素4.1%,阿米卡星1.0%,未发现有碳青霉烯类、哌拉西林/他唑巴坦、头孢替坦、呋喃妥因耐药菌株。CTX-M-14为ESBLs主要的基因型(35.29%),其次为CTX-M-27(29.41%)。MLST分型中,ST131为主要的克隆型(14.71%),其次为ST1193(8.82%)。结论成人社区获得性尿路感染大肠埃希菌耐药性强,临床应重视标本的送检合理使用抗菌药物。

Objective To understand the adult community-acquired drug resistance of Escherichia coli urinary tract infections,and provide the basis for community-acquired urinary tract infection antibiotic usage policy.Methods In the first afinity hospital of Zhejiang University,community-acquired Escherichia coli isolated from patients with urinary tract infection and drug sensitivity tests,using PCR and sequencing methods to confirm its main ESBL genes,MLST typing the ESBL positive strains.Results There were 98 strains of community-acquired Escherichia coli urinary tract infection,producing Escherichia coli ESBL seized 34,the positive rate was 34.7%.Drug sensitive results tips its on AMP resistance drug rate highest for 724%,second for CZO 50%,and CIP 43.9%,and SXT 43.9%,and LVX 39.8%,and SAM 34.4%,and CRO 32.7%,and GEN 30.6%,on ATM 20.4%,CAZ 11.5%,FEP 7.1%,TOB 4.1%,AMK 1%,not found had Carbohydrin,and TZP,CTT,NIT drug-resistant strains.CTX-M-14 was a leading ESBLs gene types(35.29%),followed by CTX-M-27(29.41%).MLST typing,ST131 as clones(14.71%),followed by ST1193(8.82%).Conclusion In adult community-acquired urinary tract infection,Escherichia coli has strong drug resistance,so we should pay attention to the sample submission and rational use of antibiotics.