摘要
目的分析上海地区急性感染性腹泻患者沙门菌的耐药谱及其耐药基因携带情况,为临床治疗提供参考。方法对400例急性腹泻患者粪便样本进行细菌培养,疑似菌株采用Vitek MS质谱仪进行细菌鉴定及血清分型,采用最小抑菌浓度(MIC)法测定沙门菌对15种常用抗菌药物的敏感性,并采用聚合酶链反应(PCR)检测菌株相关耐药基因的携带情况。结果 22株沙门菌分离株主要的血清型为鼠伤寒沙门菌(36.4%,8/22)、肠炎沙门菌(27.3%,6/22)和伦敦沙门菌(18.2%,4/22)。22株沙门菌分离株对氨苄西林-舒巴坦的耐药率最高(95.5%),以下依次为氨苄西林、左氧氟沙星、复方磺胺甲噁唑、环丙沙星-头孢噻肟-庆大霉素、头孢唑林-头孢呋辛-头孢他啶、阿米卡星;但对于哌拉西林-他唑巴坦和亚胺培南则全部敏感。β-内酰胺类药物耐药株中blaTEM-1和blaDHA基因的携带率为23.8%(5/21);氨基糖苷类药物耐药株中aadA1基因检测携带率为25%(1/4);喹诺酮耐药菌株中qyrA4基因、qnrA基因、qnrB基因、qnrS基因、parC基因携带率分别为47.1%(8/17)、5.9%(1/17)、11.7%(2/17)、17.6%(3/17)、58.8%(10/17);磺胺类耐药株中sul I基因的携带率为66.7%(4/6)。结论分离自急性感染性腹泻患者粪便样本的沙门菌总体耐药率较高,对不同药物的耐药率有差异,耐药菌株携带的耐药基因与国内其他地区有所不同,提示沙门菌耐药表型和耐药机制复杂,临床需要进行相关检测并采取个体化精准治疗。
Objective To analyze the drug resistance profile and related genes of Salmonella isolated from patients with acute infectious diarrhea in Shanghai,and to provide a reference for clinical diagnosis and treatment.Methods A total of400stool samples of patients with acute infectious diarrhea were collected for bacterial culturing.The suspected isolates and their serotypes were identified by Vitek MS.The susceptibilities of15commonly-used antibiotics against Salmonella were determined by minimum inhibitory concentration(MIC),and the related genes were determined by polymerase chain reaction(PCR).Results The dominant serotypes of22Salmonella isolates were Salmonella typhimurium(36.4%,8/22),Salmonella enteritidis(27.3%,6/22)and Salmonella london(18.2%,4/22).The22Salmonella isolates had the highest resistance rates to ampicillin/sulbactam(95.5%),followed by ampicillin,levofloxacin,trimethoptim,sulfamethoxazole,ciprofloxacin-cefotaxime-gentamicin,cefazolin-cefuroxime-ceftazidime and amikacin.Piperacillin-tazobactam and imipenem had the susceptibility rate100%.The positive rate of blaTEM-1gene and blaDHA gene in beta-lactamase resistant isolates was23.8%(5/21).The positive rate of aadA1gene in aminoglycoside resistant isolates was25%(1/4).The positive rates of qyrA4,qnrA,qnrB,qnrS and parC genes in quinolone resistant isolates were47.1%(8/17),5.9%(1/17),11.7%(2/17),17.6%(3/17)and58.8%(10/17).The positive rate of sulI gene in sulfonamide resistant isolates was66.7%(4/6).Conclusions The drug resistances of Salmonella are high and vary,and the related genes are different from the results of other domestic literatures,which indicates that the drug resistance mechanism of Salmonella is complex and the need to take individual and accurate diagnosis for personalized treatment.
作者
张景皓
杨峰
方毅
杨丽华
刘文健
赵虎
张艳梅
ZHANG Jinghao;YANG Feng;FANG Yi;YANG Lihua;LIU Wenjian;ZHAO Hu;ZHANG Yanmei(Department of Clinical Laboratory,Huadong Hospital,Fudan University,Shanghai 200040,China;Shanghai Songjiang Center for Disease Control and Prevention,Shanghai 201620,China)
出处
《检验医学》
CAS
2018年第12期1098-1102,共5页
Laboratory Medicine
基金
上海申康医院发展中心新兴前沿技术联合攻关项目(SHDC12015107)
上海市科委引导项目(16411968000)
关键词
沙门菌
急性感染性腹泻
耐药谱
耐药基因
Salmonella
Acute infectious diarrhea
Drug resistance profile
Drug resistance gene
