【摘要】：目的了解某醫(yī)院近3年來產(chǎn)超廣譜β-內(nèi)酰胺酶(extended spectrumβ-lactamases,ESBLs)大腸埃希菌感染分布以及耐藥性變化,檢測ESBLs基因型,為臨床合理治療大腸埃希菌感染提供依據(jù)。方法收集某院2014年1月~2016年10月從臨床各類標(biāo)本中分離培養(yǎng)鑒定的316株大腸埃希菌,采用梅里埃VITEK 2 COMPACT全自動(dòng)細(xì)菌分析儀進(jìn)行藥物敏感試驗(yàn)并篩選ESBLs菌株,初篩ESBLs陽性菌株進(jìn)一步采用雙紙片瓊脂擴(kuò)散法進(jìn)行確認(rèn)。采用PCR技術(shù)分別檢測產(chǎn)ESBLs菌株的CTX-M、TEM、SHV和OXA基因型。結(jié)果(1)產(chǎn)ESBLs大腸埃希菌的檢出率為41.5%(131/316),檢出率較高的標(biāo)本為分泌物和尿液(47.5%和45.8%),不同標(biāo)本之間ESBLs菌株的檢出率無顯著性差異(P0.05);2014年、2015年和2016年ESBLs菌株的檢出率分別為44.8%(43/96)、39.6%(44/111)和40.4%(44/109),亦無顯著性差異(P0.05)。(2)大腸埃希菌對(duì)青霉素類、喹諾酮類和部分頭孢菌素類等抗菌藥物耐藥率較高(47.7%~81.4%),而其中產(chǎn)ESBLs菌株對(duì)這些藥物的耐藥率高達(dá)67.9%~100%,大腸埃希菌對(duì)阿米卡星、厄他培南、哌拉西林/他唑巴坦、頭孢替坦和亞胺培南的耐藥率低于5%。產(chǎn)ESBLs菌株對(duì)多數(shù)抗菌藥物的耐藥率高于非產(chǎn)ESBLs的菌株,差異有顯著性(P0.05)。不同年份之間大腸埃希菌及產(chǎn)ESBLs菌株耐藥率有一定差異,但差異不明顯。(3)43株產(chǎn)ESBLs菌株有24株攜帶CTX-M基因,占55.8%;2株攜帶TEM基因,占7.0%,未擴(kuò)增出SHV基因和OXA基因。結(jié)論(1)該院各類標(biāo)本來源大腸埃希菌均可檢測到ESBLs菌株,近3年檢出率無明顯變化。(2)大腸埃希菌對(duì)多種抗菌藥物產(chǎn)生耐藥性,產(chǎn)ESBLs菌株耐藥現(xiàn)象更為嚴(yán)重,臨床應(yīng)加強(qiáng)病原菌檢測,依據(jù)藥敏結(jié)果合理選擇抗菌藥物。(3)該院大腸埃希菌ESBLs基因型以CTX-M為主。
[Abstract]:Objective to investigate the distribution and drug resistance of extended-spectrum 尾 -lactamase (extended spectrum 尾-lactamases,ESBLs) Escherichia coli in a hospital in recent three years, and to detect the genotype of ESBLs in order to provide evidence for clinical treatment of Escherichia coli infection. Methods from January 2014 to October 2016, 316 strains of Escherichia coli were isolated and identified from clinical specimens. Merier VITEK 2 COMPACT automatic bacterial analyzer was used for drug sensitivity test and screening of ESBLs strains. ESBLs positive strains were further identified by double disk Agar diffusion method. CTX-M,TEM,SHV and OXA genotypes of ESBLs producing strains were detected by PCR. Results (1) the positive rate of ESBLs producing Escherichia coli was 41.5% (131 / 316), and the higher detection rate was secretion and urine (47.5% and 45.8%). There was no significant difference in the detection rate of ESBLs among different specimens (P0.05). The detection rates of ESBLs strains in 2014, 2015 and 2016 were 44.8% (43 / 96), 39.6% (44 / 111) and 40.4% (44 / 109), respectively. There was no significant difference (P0.05). (2) between Escherichia coli and penicillin. The resistance rate of quinolones and some cephalosporins was higher (47.7%, 81.4%), and the resistance rate of ESBLs producing strains to these drugs was as high as 67.9%, and Escherichia coli was resistant to amikacin and ertapenem. The resistance rates of piperacillin / tazobactam, ceftitan and imipenem were lower than 5%. The resistance rate of ESBLs producing strains to most antimicrobial agents was higher than that of non-ESBLs producing strains (P0.05). There were some differences in drug resistance of Escherichia coli and ESBLs producing strains between different years, but the difference was not obvious. (3) 24 strains of 43 ESBLs producing strains carried CTX-M gene, accounting for 55.8%; The two strains carried TEM gene, accounting for 7.0%, and no SHV gene and OXA gene were amplified. Conclusion (1) Escherichia coli from all kinds of specimens in our hospital can be detected with ESBLs strain, and the detection rate of Escherichia coli has no obvious change in the past three years. (2) Escherichia coli is resistant to many kinds of antimicrobial agents, and the drug resistance of ESBLs producing strain is more serious. Clinical examination of pathogenic bacteria should be strengthened and antibiotics should be reasonably selected according to the results of drug sensitivity. (3) the ESBLs genotype of Escherichia coli in our hospital was mainly CTX-M.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R446.5

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