天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1266-1270.doi: 10.11958/20170791

• 临床研究 • 上一篇    下一篇

急性腹泻患者奇异变形杆菌对抗菌药物的耐药研究

夏琳林 1， 杨杰 1， 郇娟 1， 戈红雨 2， 赵展 1， 刘晓霞 1， 王玉宝 1△   

  1. 作者单位： 1 天津医科大学第二医院感染性疾病研究所 （邮编 300211）； 2 天津医科大学总医院感染科 作者简介： 夏琳林 （1991）， 男， 硕士， 主要从事感染性疾病的基础与临床研究 △通讯作者 E-mail: wyb2046@163.com
  • 收稿日期:2017-07-05 修回日期:2017-10-11 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 夏琳林 E-mail:475564753@qq.com

Antibiotics resistance of Proteus mirabilis isolated from patients with acute diarrhea

XIA Lin-lin1, YANG Jie1, HUAN Juan1, GE Hong-yu2, ZHAO Zhan1, LIU Xiao-xia1, WANG Yu-bao1△   

  1. 1 Institute of Infectious Disease, the Second Hospital of Tianjin Medical University, Tianjin 300211, China; 2 Department of Infectious Diseases, Tianjin Medical University General Hospital △Corresponding Author E-mail: wyb2046@163.com
  • Received:2017-07-05 Revised:2017-10-11 Published:2017-12-15 Online:2017-12-15
  • Contact: Lin-Lin XIA E-mail:475564753@qq.com

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摘要： 目的 了解分离自急性腹泻患者奇异变形杆菌的耐药状况， 为防治其感染与合理使用抗菌药物提供依 据。方法 收集 2013—2014 年天津医科大学第二医院和天津医科大学总医院肠道门诊急性腹泻患者粪便标本进 行分离培养和生化鉴定， 对鉴定得到的奇异变形杆菌进行抗菌药物敏感性试验和 1 类整合子聚合酶链式反应 （PCR） 扩增， 对部分可疑菌株进行超广谱 β-内酰胺酶 （ESBLs） 表型确证试验和 PCR 扩增 ESBLs 基因 （TEM、 OXA 和 CTXM） 并测序， 对 ESBLs 阳性菌株进行脉冲场凝胶电泳 （PFGE） 分型。结果 共非重复分离到奇异变形杆菌 277 株， 对 其中 268 株进行了药敏试验（其余 9 株未能复苏成功）。耐药率较高的为甲氧苄啶/磺胺甲噁唑（30.2%）、 氨苄西林 （25.4%）、 萘啶酸 （25.7%）、 链霉素 （21.6%） 和氯霉素 （21.3%）， 多重耐药率为 24.6% （66/268）。对三代头孢、 环丙沙星 和亚胺培南等的耐药率小于 10%， 但有 4 株菌对亚胺培南、 三代头孢、 氟喹诺酮、 复方磺胺和氯霉素均不敏感。1 类 整合子阳性率为 22.8% （61/268）。在头孢噻肟耐药株中随机选取的 3 株菌 （1062、 1505 和 1650） ESBLs 表型均阳性， 均携带 CTX-M 型超广谱 β-内酰胺酶基因， 其中 2 株还同时携带 TEM 和（或） OXA 非超广谱 β-内酰胺酶基因。 PFGE 聚类分析显示， 1505 和 1650 相似度为 85.7%， 前两者与 1062 相似度为 58.1%。结论 本地区急性腹泻患者 分离的奇异变形杆菌呈现明显多重耐药， 1 类整合子携带率较高， 出现 ESBLs 阳性且同时对碳青霉烯和氟喹诺酮均 耐药的菌株， 对公众健康构成威胁， 临床和非临床领域均需要合理使用抗菌药物。

关键词: 腹泻, 变形杆菌属, 抗药性, 多种, 细菌, 1 类整合子, 奇异变形杆菌, 超广谱 β-内酰胺酶, 脉冲场凝胶 电泳

Abstract: Objective To investigate antibiotics resistance of Proteus mirabilis isolated from stools of patients with acute diarrhea for the prevention and treatment of its infection and the rational use of antibiotics. Methods Stool samples of acute diarrhea patients were collected in the diarrhea outpatient clinic of the Second Hospital of Tianjin Medical University and Tianjin Medical University General Hospital from 2013 to 2014. Enrichment culture and biochemical identification were used to isolate and identify Proteus mirabilis, which were further performed antimicrobial susceptibility testing and class 1 integron detection. Extended spectrum β-lactamases (ESBLs) phenotype and ESBLs genes (TEM, OXA and CTX-M) were amplified by polymerase chain reaction (PCR), and sequencing were carried on in parts of suspected isolates. ESBLspositive strains were analyzed by pulsed-field gel electrophoresis (PFGE). Results A total of 277 strains of non-repetitive Proteus mirabilis were isolated, and 268 of them were performed antimicrobial susceptibility testing (the remaining 9 strains failed to recover). Relative higher resistant rates were trimethoprim/sulfamethoxazole (30.2%), ampicillin (25.4%), nalidixic acid (25.7%), streptomycin (21.6%) and chloramphenicol (21.3%). The multiple drug resistance rate was 24.6% (66/268). The positive rate of class 1 integron was 22.8% (61/268). Resistance rates to third-generation cephalosporin, ciprofloxacin and imipenem were less than 10%, but 4 isolates were resistant to imipenem, third-generation cephalosporin, fluoroquinolones, trimethoprim / sulfamethoxazole, and chloramphenicol simultaneously. Three cefotaxime-resistant strains (1062, 1505 and 1650) were positive for ESBLs phenotype and harbored CTX-M extended-spectrum β-lactamase genes, among them 2 strains also carried TEM and / or OXA β - lactamase genes. The clustering analysis of pulsed-field gel electrophoresis (PFGE) displayed that the similarities between 1505 and 1650 were 85.7%, and the similarity with 1062 was 58.1%. Conclusion Proteus mirabilis isolated from patients with acute diarrhea in our city show significant multidrug resistance, high positive rate of class 1 integron, and emergence of ESBLs-positive strains resistant to imipenem and fluoroquinolones, which pose a threat to public health. Rational use of antibiotics is important in both clinical and nonclinical settings.

Key words: diarrhea, Proteus, drug resistance, multiple, bacterial, class 1 integron, Proteus mirabilis, extended spectrum β-lactamases, pulsed-field gel electrophoresis