本文關(guān)鍵詞： 嗜麥芽窄食單胞菌 多位點(diǎn)序列分型 脈沖場凝膠電泳　出處：《中國感染與化療雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的研究上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院成人患者分離嗜麥芽窄食單胞菌的分子流行病學(xué)特征,為嗜麥芽窄食單胞菌的感控提供數(shù)據(jù)支持。方法收集2014年1-9月該醫(yī)院成人患者分離的非重復(fù)嗜麥芽窄食單胞菌,采用多位點(diǎn)序列分型(MLST)和脈沖場凝膠電泳(PFGE)方法分析其克隆特點(diǎn);用紙片擴(kuò)散法測定3種抗菌藥物(左氧氟沙星,甲氧芐啶-磺胺甲唑,米諾環(huán)素)的敏感性;PCR檢測4種主要毒力基因(Stmpr1,Stmpr2,smf-1,Smlt3773locus);采用半定量生物膜形成試驗(yàn)分析其生物膜形成能力;同時(shí)收集和分析患者的臨床信息。結(jié)果共收集78株嗜麥芽窄食單胞菌,26株來自外科監(jiān)護(hù)室,其余較為分散。檢出患者以男性為主占67.9%(53/78),在分離出嗜麥芽窄食單胞菌之前都有抗菌藥物應(yīng)用史,62.8%患者使用3種以上抗菌藥物。MLST分析檢測出38種新的ST型,命名為STnew1-STnew38,嗜麥芽窄食單胞菌的型別較為分散,較多的ST23型只有6株,克隆流行傳播趨勢不明顯。PFGE顯示78株菌株分成58個(gè)簇群,無明顯聚集的簇群。78株菌株對左氧氟沙星、甲氧芐啶-磺胺甲唑的耐藥率分別為2.6%(2/78)、10.3%(8/78),所有菌株對米諾環(huán)素均敏感。Stmpr1、Stmpr2、smf-1和Smlt3773locus毒力基因陽性率分別為79.5%(62/78)、93.6%(73/78)、94.9%(74/78)和48.7%(38/78)。生物膜形成試驗(yàn)結(jié)果顯示:生物膜形成能力平均值為D_(492)=0.51±0.44,不同性別的患者中無明顯差異。結(jié)論嗜麥芽窄食單胞菌檢出患者以男性居多,感染患者大多有抗菌藥物應(yīng)用史,毒力基因攜帶率較高。未發(fā)現(xiàn)同一科室明顯的克隆傳播。
[Abstract]:Objective to study the molecular epidemiological characteristics of isolated Stenotrophomonas maltophilia from adult patients in Renji Hospital affiliated to Shanghai Jiaotong University Medical College. Methods Non-repetitive Stenotrophomonas maltophilia isolated from adult patients in the hospital from 2014 to September was collected. Multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE) were used to analyze their cloning characteristics. The sensitivity of three antimicrobial agents (levofloxacin, trimethoprim sulfamethazole and minocycline) was determined by disk diffusion method. Four major virulence genes, Stmpr1, Stmpr2, smf-1, Smlt3773locusa, were detected by PCR. The biofilm forming ability was analyzed by semi-quantitative biofilm formation test. Results A total of 78 strains of Stenomonas maltophilia were collected from surgical intensive care unit. The other patients were more dispersed. The majority of the patients were male (67.9%) and 53% (78%). All of them had a history of antimicrobial application before isolation of Stenotrophomonas maltophilia. 62.8% patients used more than 3 antimicrobial agents. MLST analysis detected 38 new St types named STnew1-STnew38. The types of Stenotrophomonas maltophilia were scattered. There were only 6 strains of ST23 type. The trend of clone epidemic transmission was not obvious. PFGE showed that 78 strains were divided into 58 clusters, and no obvious cluster group. 78 strains showed levofloxacin. The drug resistance rates of trimethoprim and sulfamethazol were 2. 6 / 78 / 10. 3 and 8 / 78 / 78 respectively. All strains were sensitive to minocycline. Stmpr1 and Stmpr2. The positive rates of smf-1 and Smlt3773locus virulence genes were 79.5% and 79.2%, respectively. The biofilm formation test showed that the average biofilm forming ability was 0.51 鹵0.44. There was no significant difference between different genders. Conclusion most of the patients were male and most of the infected patients had a history of antimicrobial drug use in the diagnosis of Stenotrophomonas maltophilia. The virulence gene carrying rate was high. No significant clone transmission was found in the same department.
【作者單位】： 復(fù)旦大學(xué)附屬華山醫(yī)院檢驗(yàn)科;復(fù)旦大學(xué)附屬婦產(chǎn)科醫(yī)院研究所;上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院檢驗(yàn)科;
【基金】：國家自然科學(xué)基金(81601853) 上海市衛(wèi)計(jì)委青年科研項(xiàng)目(20164Y0105)
【分類號】：R446.5
【正文快照】： 不發(fā)酵糖革蘭陰性桿菌嗜麥芽窄食單胞菌(Stenotrophomonas maltophilia),廣泛存在于水體和環(huán)境中[1]。其主要引起呼吸系統(tǒng)感染[2],也可引起尿路感染、關(guān)節(jié)感染和皮膚感染等[3]。隨著臨床上各種抗生素和免疫抑制劑的應(yīng)用及侵襲性醫(yī)療設(shè)備的廣泛使用,患者免疫力下降,導(dǎo)致該菌的

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