福建省多重耐药及产ESBL志贺菌耐药特征分析

Analysis on characteristic of the multi-drug resistant and extended-spectrum beta lactamase (ESBL)-producing clinical isolates of shigella,Fujian province

目的了解福建地区多重耐药和产超广谱β-内酰胺酶(ESBL)志贺菌耐药表型及ESBL相关耐药基因的分布情况。方法收集福建地区2005～2015年志贺菌临床分离株102株,最小抑菌浓度(MIC)法检测药敏情况和产ESBL菌株,聚合酶链反应(PCR)检测ESBL相关耐药基因。结果 102株中97株为多重耐药志贺菌(Multidrug resistance shigella,MDRS),对7种抗菌素耐药率>70.00%。在11年间,头孢类抗生素、氨曲南的耐药率出现先上升后下降的趋势;而庆大霉素和复方新诺明的耐药率出现缓慢下降的趋势。检出产ESBL志贺菌24株(23.53%、24/102),其中福氏8株,宋内16株,CTX-M-Ⅰ、CTX-M-Ⅱ、CTX-M-Ⅳ、TEM、SHV和OXA在产ESBL和不产ESBL志贺菌中均有检出;CTX-M-Ⅱ、CTX-M-Ⅳ和SHV在产ESBL和不产ESBL志贺菌中的分布差异有统计学意义(P<0.01)。结论福建地区多重耐药和产ESBL志贺菌流行广泛;多种耐药基因可能在志贺菌产ESBL的耐药机制中发挥重要作用。

Objective To understand the drug resistance phenotype,patterns of extended-spectrum beta lactamase(ESBL)resistance genes of multi-drug resistance(MDR)and ESBL-producing shigella clinical isolates in Fujian province.Methods A total of 102 isolates were collected during 2005-2015.The minimum inhibitory concentration(MIC)method was used to perform antimicrobial susceptibility test and determine ESBL producing strains.Polymerase chain reaction(PCR)was used to detect ESBL resistance genes.Results A total of 97 strains(97/102)were found to be multidrug-resistant shigella,with the resistance rates to the 7 antimicrobials of>70%.In the past 11 years,the drug resistance rates of cephalosporin and aztreonam increased firsty and then decreased,while them of gentamicin and trimethoprim/sulfamethoxazole decreased slowly.There was 23.53%(24/102)ESBL-producing isolates were detected,among which 8 were S.flexneri and 16 were S.sonnei.CTX-M-Ⅰ,Ⅱ,Ⅳ,TEM,SHV and OXA were detected both in the ESBL-producing and non ESBL-producing isolates.There was statistical significant difference between the ESBL-producing and non ESBL-producing isolates in the distribution of gene CTX-M-Ⅱ,CTX-M-Ⅳand SHV(P<0.05).Conclusion Multidrug-resistant and ESBL-producing shigella isolates are prevalent in Fujian province.A number of ESBL genes may play an important role in the mechanism of ESBL-producing resistance of shigella.