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目的:分析腹泻患者体内大肠埃希菌(E.coli)的基因分型及其耐药特征。方法:选取2012年12月—2014年12月间收治的腹泻患者500例,采集其粪便标本培养,检测产志贺毒素E.coli、肠凝聚性E.coli、非典型肠致病性E.coli、肠侵袭性E.coli、肠产毒性E.coli和未分型E.coli菌株,并对致病菌基因的特异性引物进行了多重PCR测定,分离出致泻性大肠杆菌(diarrheagenic E.coli,简称DE.coli)各型菌株;采用微量稀释药敏试验法检测DE.coli对常用抗菌药物的耐药性。结果:500例腹泻患者中,从150例(占30.00%)患者中分离出DE.coli菌株170株,其中肠凝聚性E.coli为115株(占67.65%),肠致病性E.coli为8株(占4.71%),非典型肠致病性E.coli为11株(占6.47%),产志贺毒素E.coli为2株(占1.18%),肠侵袭性E.coli为1株(占0.59%)和未分型为33株(占19.41%);DE.coli对氨苄西林(AMP)和哌拉西林(PIP)的耐药率为最高,分别为70.00%和60.59%以及对亚胺培南(IMP)、哌拉西林-他唑巴坦(TZP)及美罗培南(MER)的耐药率为0。结论:腹泻患者感染的最常见病原菌为肠凝聚性E.coli,其次为非典型肠致病性E.coli;DE.coli对常用抗菌药物的耐药性各不相同,在临床抗菌治疗前需要确定DE.coli的类型,并加强对细菌耐药性的监测,以促进抗菌药物的合理使用。
Objective: To analyze the genotyping and drug resistance of Escherichia coli in diarrhea patients. Methods: 500 cases of diarrhea patients who were admitted between December 2012 and December 2014 were enrolled in this study. Stool specimens were collected and cultured to detect Shiga toxin E.coli, intestinal aggregate E.coli, and atypical intestinal pathogenic E. coli. coli, enteropathogenic E.coli, enterotoxigenic E.coli and undifferentiated E.coli strains. Multiplex PCR was performed on the specific primers of the pathogen genes to isolate diarrheagenic E.coli .coli, referred to as DE.coli) various types of strains; using microdilution susceptibility test method DE.coli commonly used antimicrobial resistance. Results: Of the 500 patients with diarrhea, 170 strains of DE.coli were isolated from 150 patients (30.00%), of which 115 were intestinal aggregation (67.65%), enteropathogenic E. coli 8 strains (accounting for 4.71%), 11 strains of enteric pathogenic E.coli (6.47%), 2 strains producing Shiga toxin (1.18%), intestinal invasive E.coli 1 strain (accounting for 0.59%) and 33 strains (19.41%). The drug resistance rates of DE.coli to ampicillin (AMP) and piperacillin (PIP) were the highest, which were 70.00% and 60.59% And resistance rates to imipenem (IMP), piperacillin-tazobactam (TZP) and meropenem (MER) were zero. CONCLUSIONS: The most common pathogen of diarrhea patients is intestinal aggregate E.coli, followed by atypical enteropathogenic E. coli. DE.coli has different resistance to commonly used antimicrobials, which is required before clinical antimicrobial treatment Determine the type of DE.coli and strengthen the monitoring of bacterial resistance to promote the rational use of antimicrobial agents.