2016—2018年河北承德地区大肠埃希菌诱发急性腹泻病原学和耐药性分析

Pathogenic study and drug resistance analysis of acute diarrhea induced by Escherichia Coli in Chengde Area in 2016-2018

目的对2016—2018年承德地区临床分离的致病性大肠埃希菌进行病原学研究及耐药性分析,为该地区流行病学研究及临床合理使用抗菌药物提供客观依据。方法收集2016—2018年承德地区某门诊702例腹泻患者粪便,采用常规病原菌检验流程对其进行分离制备,对疑似大肠埃希菌的标本进行多重PCR及单重PCR实验进行鉴定;采用全自动微生物鉴定及药敏分析仪Vitek2 compact对DEC进行15种抗生素药物体外敏感实验。结果从702例腹泻患者粪便中分离得到DEC 189株,检出率为26.92%。189株DEC中,EAEC检出率最高,占57.67%,其次为ETEC占32.80%,随后为EPEC占6.35%,混合型占3.17%,EIEC、EHEC未检出。携带的毒力基因以ast A、est Ib、esc V为主。各型DEC全年均有检出,其中6~8月检出率最高,29.19%,患者主要集中在20~45岁,男女检出率为25.86%、27.97%。除EPEC检出受季节及年龄影响外,其余各型DEC检出均不受季节、性别及年龄影响。DEC对氨苄西林耐药率最高,为62.96%,对复方新诺明、环丙沙星及庆大霉素的耐药率分别为51.32%、49.74%、30.16%,其余11种药物耐药率均低于20%,其中所有菌株均对美罗培南敏感无耐药性。189株DEC菌株中,产ESBLs菌株占比1.59%。多重耐药株占32.80%。结论DEC为承德地区引起胃肠道感染最常见的细菌性病原体,临床实验室应加强对本地区DEC的监测力度,尤其侧重携带多种毒力基因、产ESBLs及多重耐药菌株,及时掌握细菌耐药性的动态状况,进而指导临床合理用药,延缓及减少细菌耐药性的产生。

Objective To study the etiology and drug resistance of escherichia coli isolated from clinic in Chengde from 2016 to 2018,and to provide an objective basis for the epidemiological study and clinical rational use of antimicrobial agents.Methods The feces of 702 diarrhea patients in an outpatient clinic in Chengde district from 2016 to 2018 were collected,isolated and prepared by conventional pathogen testing procedures,and the specimens suspected of escherichia coli were identified by multiple PCR and single PCR experiments.DEC was sensitized to 15 antibiotic drugs in vitro by automatic microbiological identification and drug sensitivity analyzer Vitke-2 compact.Results A total of 189 DEC strains was isolated from the feces of 702 diarrhea patients,and the detection rate was 26.92%.Among 189 DEC strains,EAEC had the highest detection rate(57.67%),followed by ETEC(32.80%),then EPEC(6.35%)and mixed(3.17%).EIEC and EHEC were not detected.The virulence genes were mainly ast A、est Ib and esc V.All types of DEC were detected throughout the year,with the highest detection rate(29.19%)between June and August.The patients were mainly aged between 20 and 45 years old,and the detection rate was 25.86%and 27.97%for men and women.The detection of EPEC was not affected by season,sex or age,except by season and age.DEC had the highest resistance to ampicillin at 62.96%,51.32%,49.74%and 30.16%to cotrimoxazole,ciprofloxacin and gentamicin,and less than 20%to the other 11 drugs,all of which were sensitive to meropenem but not resistant.Among 189 DEC strains,esbl-producing strains accounted for 1.59%.Multiple resistant strains accounted for 32.80%.Conclusion DEC for Chengde area of the most common bacterial pathogens in gastrointestinal tract infection,clinical laboratory should strengthen the monitoring of the region DEC,especially to carry on a variety of virulence genes,ESBL producing and multiple drug resistance strains,timely grasp the dynamics of bacterial drug resistance,and to guide clinical rational drug use,delay and reduce the generation of bacterial drug resistance.