浙江省县市级医院社区发作大肠埃希菌和肺炎克雷伯菌血流感染患者产超广谱β-内酰胺酶情况分析

发布时间：2018-05-18 20:42

本文选题：超广谱β-内酰胺酶 + 社区发作　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:本研究旨在明确浙江省9家县市级医院社区发作血流感染中产超广谱β-内酰胺酶(extended-spectrum beta-lactamases,ESBLs)大肠埃希菌和肺炎克雷伯菌的流行情况及基因型分布。方法:本研究采用多中心、前瞻性、观察性研究方法,在2014年3月1日至2015年4月30日期间,连续收集浙江省9家县市级医院大肠埃希菌及肺炎克雷伯菌导致的社区发作血流感染病例及分离菌株,采用双纸片扩散法进行ESBLs表型确证试验,PCR(Polymerase ChainReaction)扩增及序列分析明确ESBLs基因型,多位点序列分型(Multiple Locus Sequence Typing,MLST)分析确证ESBLs阳性菌株的分子流行病学特征;体外药物敏感试验测定产ESBLs菌株常用抗菌药物最低抑菌浓度(Minimal Inhibitory Concentrations,MICs)。结果共收集到社区发作血流感染病例172例,其中符合研究要求病例171例,分离到致病菌171株,分别为大肠埃希菌126株及肺炎克雷伯菌45株。社区发作血流感染ESBLs的检出率为34.5%(59/171),其中大肠埃希菌和肺炎克雷伯菌的ESBLs的检出率分别为41.3%(52/126)和15.6%(7/45)。所有产ESBLs菌株中产 CTX-M 型占 96.6%(57/59),其中最常见的为 CTX-M-14(27.1%,16/59)和CTX-M-55(22.0%,13/59)。MLST 结果显示,产 ESBLs 大肠埃希菌以 ST131 为主,占23.1%(12/52)。体外药物敏感试验结果显示,碳青霉烯类抗菌药物、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、拉氧头孢、阿米卡星及磷霉素对产ESBLs的大肠埃希菌和肺炎克雷伯菌具有较好的抗菌活性。结论:浙江省9家县市级医院社区发作血流感染所分离的大肠埃希菌和肺炎克雷伯菌存在较高的ESBLs分离率,基因型以CTX-M-14和CTX-M-55为主。大肠埃希菌ESBLs的检出率显著高于肺炎克雷伯菌。碳青霉烯类抗菌药物、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、拉氧头孢、阿米卡星及磷霉素对ESBLs阳性菌株有较好的体外抗菌活性。
[Abstract]:Objective: to investigate the prevalence and genotype distribution of extended-spectrum beta-lactamases (extended-spectrum beta-lactamases) Escherichia coli (ESBLs) and Klebsiella pneumoniae (Klebsiella pneumoniae) in 9 hospitals in Zhejiang province. Methods: a multicenter, prospective and observational study was used between March 1, 2014 and April 30, 2015. Cases of blood stream infection caused by Escherichia coli and Klebsiella pneumoniae were collected from 9 county and municipal hospitals in Zhejiang Province. The polymerase chain reaction amplification and sequence analysis were performed to identify the ESBLs genotypes by double disk diffusion. The molecular epidemiologic characteristics of the ESBLs positive strains were confirmed by multiple Locus Sequence typing. In vitro antimicrobial susceptibility test was used to determine the minimum inhibitory concentration (MEC) of common antimicrobial agents produced by ESBLs strains. Results 172 cases of blood flow infection in community were collected. 171 cases were found to meet the requirements of the study, 171 strains of pathogenic bacteria were isolated, 126 strains of Escherichia coli and 45 strains of Klebsiella pneumoniae were isolated. The detection rate of ESBLs in community was 34.5g / 171g. The detection rate of ESBLs of Escherichia coli and Klebsiella pneumoniae was 41.3 / 126 and 15.6/ 45 respectively. Of all the strains producing ESBLs, the CTX-M type accounted for 96.6 / 59.The most common of them were CTX-M-1427.1and 16 / 59) and CTX-M-550.22.0and 13 / 590.MLST results showed that ST131 was the main type of Escherichia coli producing ESBLs, accounting for 12.1% 52.The results showed that the most common CTX-M producing strains were CTX-M-1427.1and CTX-M-550.22.00.The results showed that ST131 was the main type of Escherichia coli producing ESBLs, accounting for 12.1% 52.2%. The results of in vitro drug sensitivity tests showed that carbapenems, cefoperazone / sulbactam, piperacillin / tazobactam, oxycefosporium, cefoperazone / sulbactam, cefoperazone / sulbactam Amikacin and fosfomycin have good antibacterial activity against Escherichia coli and Klebsiella pneumoniae which produce ESBLs. Conclusion: there is a high ESBLs isolation rate of Escherichia coli and Klebsiella pneumoniae isolated from community blood stream infection in 9 county and city hospitals in Zhejiang Province. CTX-M-14 and CTX-M-55 are the main genotypes of Escherichia coli and Klebsiella pneumoniae. The detection rate of Escherichia coli ESBLs was significantly higher than that of Klebsiella pneumoniae. Carbapenem antibiotics, cefoperazone / sulbactam, piperacillin / tazobactam, oxycefosporium, amikacin and fosfomycin have good antibacterial activity against ESBLs positive strains in vitro.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R515;R446.5

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