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目的了解本地区基层医院大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的情况及其耐药性和基因型特点,为临床治疗提供依据。方法收集2014年3月至2015年3月广州市番禺区基层医院临床各类标本中分离得到的大肠埃希菌,采用纸片扩散法检测产ESBLs菌株,通过全自动细菌药敏仪检测实验菌株的药敏结果,PCR法检测bla_(CTX-M-1)、bla_(CTX-M-2)、bla_(CTX-M-9)和bla_(SHV)基因。结果各类临床标本共分离到产ESBLs大肠埃希菌株50株,阳性率为43.9%(50/114)。50株产ESBLs大肠埃希菌对阿莫西林、哌拉西林、头孢噻吩、头孢呋辛100%耐药;对头孢噻肟耐药率为82%、对复方新诺明耐药率为66%、对庆大霉素耐药率为70%、对氨曲南耐药率为50%、对左氧氟沙星和环丙沙耐药率分别为70%和80%。其中33株(66%)携带bla_(CTX-M-9)亚群基因,19株(38%)携带bla_(CTX-M-1)亚群基因,6株同时含上述2种基因。未检测出bla_(CTX-M-2)、bla_(SHV)型基因。结论基层医院大肠埃希菌产ESBLs率较高,其基因型以携带bla_(CTX-M-9)亚群基因为主。
Objective To understand the ESBLs-producing status of Escherichia coli and its drug resistance and genotype in primary hospitals in the region, and to provide basis for clinical treatment. Methods Escherichia coli isolated from clinical specimens of Panyu District, Guangzhou City from March 2014 to March 2015 were collected. The ESBLs producing strains were detected by disk diffusion method. The experimental strains (CTX-M-1), bla_ (CTX-M-2), bla_ (CTX-M-9) and bla_ (SHV) were detected by PCR. Results All kinds of clinical samples were isolated ESBLs-producing Escherichia coli strains 50, the positive rate was 43.9% (50/114). Fifty ESBLs-producing Escherichia coli strains were resistant to amoxicillin, piperacillin, cefalotin and cefuroxime, resistant to cefotaxime 82% and resistant to cotrimoxazole 66% , The rate of gentamicin was 70%, the rate of resistance to aztreonam was 50%, and the rates of resistance to levofloxacin and ciprofloxacin were 70% and 80% respectively. Among them, 33 strains (66%) carried bla_ (CTX-M-9) subunit gene and 19 (38%) carried bla_ (CTX-M-1) subunit gene. No bla_ (CTX-M-2) or bla_ (SHV) was detected. Conclusions ESBLs-producing strains of Escherichia coli in grass-roots hospitals have a high incidence of ESBLs, and their genotypes are mainly those carrying the bla_ (CTX-M-9) subpopulation.