尿路感染患者尿液标本分离肠球菌的临床分布、耐药性及毒力特征

Clinical distribution,drug resistance and virulence characteristics of Enterococci strains isolated from urine specimens of patients with urinary tract infection

目的分析尿路感染患者尿液标本分离肠球菌的临床分布、耐药性及毒力特征。方法选取2019年6月-2021年6月海口市中医医院收治的尿路感染患者300例为研究对象,收集和分析患者送检尿液标本分离肠球菌的临床分布,采用纸片扩散法(K-B)检测肠球菌耐药情况,采用聚合酶链式反应(PCR)法检测毒力基因。结果300例尿路感染患者分离病原菌347株,检出屎肠球菌39株(11.24%)、粪肠球菌30株(8.65%);屎肠球菌和粪肠球菌在泌尿外科分布最高,其次为肛肠外科与肾内科;屎肠球菌对环丙沙星的耐药率最高(97.44%),粪肠球菌对四环素、奎奴普丁/达福普汀的耐药率最高(73.33%、70.00%),且屎肠球菌与粪肠球菌对不同抗菌药物的耐药性存在差异(P<0.05);69株尿液标本分离肠球菌中,毒力基因esp阳性率最高,其次为ace、efa,粪肠球菌毒力基因(hyl除外)阳性率均高于屎肠球菌(P<0.05)。结论医院尿液标本分离肠球菌在泌尿外科中的分布最高,对常用抗菌药物均具有较高的耐药性,同时携带多种毒力基因,应引起医院高度重视。

OBJECTIVE To explore the clinical distribution,drug resistance and virulence characteristics of Enterococci strains isolated from urine specimens of the patients with urinary tract infection.METHODS A total of 300 patients with urinary tract infection who were treated in Haikou Hospital of Traditional Chinese Medicine from Jun 2019 to Jun 2021 were enrolled in the study.The urine specimens were collected and submitted for culture of Enterococci,the drug resistance of the Enterococci strains was detected by disk diffusion method(K-B method),and the virulence genes in the strains were detected by means of polymerase chain reaction(PCR).RESULTS Totally 347 strains of pathogens were isolated from the 300 patients with urinary tract infection,39(11.24%)of which were Enterococcus faecium,and 30(8.65%)were Enterococcus faecalis.The isolation rate of E.faecium and E.faecalis was the highest in urology department,followed by anorectal surgery department and nephrology department.The drug resistance rate of the E.faecium to ciprofloxacin was the highest(97.44%),the drug resistance rate of the E.faecalis to tetracycline and quinupristin-dalfopristin was the highest(73.33%,70.00%);there were significant differences in the drug resistance rates to various antibiotics between the E.faecium and the E.faecalis(P<0.05).Among the 69 strains of Enterococci isolated from the urine specimens,the positive rate of virulence gene esp was the highest,followed by ace and efa;the positive rates of the virulence genes(except for hyl)were higher in the E.faecalis than in the E.faecium(P<0.05).CONCLUSION The isolation rate of the clinical Enterococci isolates from urine specimens is the highest in urology department,the strains are highly resistant to the commonly used antibiotics,and the strains carry with a variety of virulence genes,to which the hospital should pay great attention.