上海某医院临床分离嗜麦芽窄食单胞菌分子流行病学分析

发布时间：2018-02-02 08:48

本文关键词： 嗜麦芽窄食单胞菌多位点序列分型脉冲场凝胶电泳　出处：《中国感染与化疗杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的研究上海交通大学医学院附属仁济医院成人患者分离嗜麦芽窄食单胞菌的分子流行病学特征,为嗜麦芽窄食单胞菌的感控提供数据支持。方法收集2014年1-9月该医院成人患者分离的非重复嗜麦芽窄食单胞菌,采用多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)方法分析其克隆特点;用纸片扩散法测定3种抗菌药物(左氧氟沙星,甲氧苄啶-磺胺甲唑,米诺环素)的敏感性;PCR检测4种主要毒力基因(Stmpr1,Stmpr2,smf-1,Smlt3773locus);采用半定量生物膜形成试验分析其生物膜形成能力;同时收集和分析患者的临床信息。结果共收集78株嗜麦芽窄食单胞菌,26株来自外科监护室,其余较为分散。检出患者以男性为主占67.9%(53/78),在分离出嗜麦芽窄食单胞菌之前都有抗菌药物应用史,62.8%患者使用3种以上抗菌药物。MLST分析检测出38种新的ST型,命名为STnew1-STnew38,嗜麦芽窄食单胞菌的型别较为分散,较多的ST23型只有6株,克隆流行传播趋势不明显。PFGE显示78株菌株分成58个簇群,无明显聚集的簇群。78株菌株对左氧氟沙星、甲氧苄啶-磺胺甲唑的耐药率分别为2.6%(2/78)、10.3%(8/78),所有菌株对米诺环素均敏感。Stmpr1、Stmpr2、smf-1和Smlt3773locus毒力基因阳性率分别为79.5%(62/78)、93.6%(73/78)、94.9%(74/78)和48.7%(38/78)。生物膜形成试验结果显示:生物膜形成能力平均值为D_(492)=0.51±0.44,不同性别的患者中无明显差异。结论嗜麦芽窄食单胞菌检出患者以男性居多,感染患者大多有抗菌药物应用史,毒力基因携带率较高。未发现同一科室明显的克隆传播。
[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 卤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.
【作者单位】：复旦大学附属华山医院检验科;复旦大学附属妇产科医院研究所;上海交通大学医学院附属仁济医院检验科;
【基金】：国家自然科学基金(81601853) 上海市卫计委青年科研项目(20164Y0105)
【分类号】：R446.5
【正文快照】： 不发酵糖革兰阴性杆菌嗜麦芽窄食单胞菌(Stenotrophomonas maltophilia),广泛存在于水体和环境中[1]。其主要引起呼吸系统感染[2],也可引起尿路感染、关节感染和皮肤感染等[3]。随着临床上各种抗生素和免疫抑制剂的应用及侵袭性医疗设备的广泛使用,患者免疫力下降,导致该菌的

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