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目的了解致泻性大肠埃希菌(DEC)在急性腹泻患者中的分布及对常用抗菌药物的敏感性,为疾病的防控和治疗提供依据。方法收集2014年1月至2015年12月期间就诊于浙江大学医学院附属第一医院急性腹泻患者粪便标本,采用常规病原菌检验流程对常见肠道致病菌进行分离培养鉴定,分离到的疑似大肠埃希菌采用多重PCR和单重PCR进行鉴定、分型,采用纸片扩散法(K-B法)对各型DEC进行18种常用药物敏感试验。结果从1 019例急性腹泻患者标本中分离到396株病原菌,其中DEC230株,分离率为22.6%,占所有分离菌株的58.1%,居病原菌首位。230株DEC中,ETEC占56.5%,EAEC占30.4%,EPEC占8.7%,STEC占0.4%,混合型DEC占0.9%,未发现EIEC。各型DEC全年均有检出,其中夏季(6~8月)分离率最高,达24.0%,患者主要分布在19~45岁,男女检出率分别为21.8%和23.2%,差异无统计学意义。DEC对氨苄西林的耐药率最高,达49.3%,对头孢唑林、复方新诺明、氨苄西林/舒巴坦的耐药率分别为46.4%、35.7%、30.9%,其余抗菌药物耐药率均低于15.0%,未出现亚胺培南耐药株。207株DEC中,产ESBLs菌株占41.1%,多重耐药菌株占44.9%。结论 DEC是本地区急性腹泻最常见的细菌性病原,是临床肠道感染中不可忽视的病原之一,尤其是同时携带多型别毒力基因菌株及产ESBLs菌株和多重耐药菌。长期持续监测其分布及耐药趋势,对疾病的预防、治疗具有重要意义。
Objective To understand the distribution of diarrheal Escherichia coli (DEC) in patients with acute diarrhea and the sensitivity to commonly used antimicrobial agents, so as to provide basis for disease prevention and treatment. Methods Stool samples from patients with acute diarrhea admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to December 2015 were collected. The common pathogenic bacteria were isolated and identified by routine pathogen test. The suspected large intestine Echinococcus multilocularis and single-PCR were used for identification and typing, and 18 kinds of commonly used drug sensitivity tests were performed on each type of DEC using disk diffusion method (KB method). Results 396 strains of pathogens were isolated from 1019 patients with acute diarrhea. Among them, DEC230 strains were isolated with a separation rate of 22.6%, accounting for 58.1% of all isolates, ranking first in the pathogens. Among 230 DECs, ETEC accounted for 56.5%, EAEC accounted for 30.4%, EPEC accounted for 8.7%, STEC accounted for 0.4%, mixed DEC accounted for 0.9%, and no EIEC was found. Each type of DEC was detected throughout the year, of which summer (June to August) the highest rate of separation, up to 24.0%, patients are mainly distributed in the 19 to 45 years old, male and female detection rates were 21.8% and 23.2%, no difference Significance of learning. The resistance rate of DEC to ampicillin was the highest (49.3%). The resistance rates to cefazolin, cotrimoxazole and ampicillin / sulbactam were 46.4%, 35.7% and 30.9% respectively, and the remaining antibacterials were resistant Rates were lower than 15.0%, did not appear imipenem resistant strains. Among 207 strains of DEC, ESBLs-producing strains accounted for 41.1% and multi-drug resistant strains accounted for 44.9%. Conclusion DEC is one of the most common bacterial pathogens in acute diarrhea in the region. It is one of the most important pathogens in clinical intestinal infections. In particular, it carries multiple virulence genes and ESBLs-producing strains and multi-drug resistant bacteria. Long-term continuous monitoring of its distribution and drug resistance trends, the prevention and treatment of diseases is of great significance.