2013-2019年北京市顺义区腹泻病例分离致泻性大肠埃希菌耐药特征分析

王园园 林帆 王苗 康颖 李颖 马红梅

王园园, 林帆, 王苗, 康颖, 李颖, 马红梅. 2013-2019年北京市顺义区腹泻病例分离致泻性大肠埃希菌耐药特征分析[J]. 疾病监测. doi: 10.3784/jbjc.issn.1003-9961.202102190075
引用本文: 王园园, 林帆, 王苗, 康颖, 李颖, 马红梅. 2013-2019年北京市顺义区腹泻病例分离致泻性大肠埃希菌耐药特征分析[J]. 疾病监测. doi: 10.3784/jbjc.issn.1003-9961.202102190075
Wang Yuanyuan, Lin Fan, Wang Miao, Kang Ying, Li Ying, Ma Hongmei. Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing, 2013–2019[J]. Disease Surveillance. doi: 10.3784/jbjc.issn.1003-9961.202102190075
Citation: Wang Yuanyuan, Lin Fan, Wang Miao, Kang Ying, Li Ying, Ma Hongmei. Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing, 2013–2019[J]. Disease Surveillance. doi: 10.3784/jbjc.issn.1003-9961.202102190075

2013-2019年北京市顺义区腹泻病例分离致泻性大肠埃希菌耐药特征分析

doi: 10.3784/jbjc.issn.1003-9961.202102190075
详细信息
    作者简介:

    王园园,女,山东省临沂市人,主管技师,主要从事病原微生物检测工作,Email:415809126@qq.com

    林帆,女,河北北方学院实习生,Email:2351893221@qq.com

    通讯作者:

    李颖,Tel:010–69420876,Email:liying19830805@126.com

    马红梅:Tel:010–69420044,Email:1955940163@qq.com

  • 王园园与林帆同为第一作者
  • 中图分类号: R211; R378.2+1

Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing, 2013–2019

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  • 摘要:   目的  对北京市顺义区2013 — 2019年2家哨点医院腹泻病例分离的致泻性大肠埃希菌(DEC)进行耐药特征分析。  方法  收集2013 — 2019年2家哨点医院腹泻病例粪便标本,进行DEC分离培养、生化鉴定与分型鉴定,抗菌药敏感性试验使用微量肉汤法,耐药特征分析包括耐药率、非敏感率、多重耐药率和耐药谱分析。  结果  腹泻病例DEC检出率为9.53%(232/2434)、肠产毒性大肠埃希菌(ETEC)占56.47%(131/232)、肠致病性大肠埃希菌(EPEC)占27.16%(63/232)、肠聚集性大肠埃希菌(EAEC)占16.38%(38/232)。 DEC多重耐药率为33.19%(77/232),共有90种耐药谱型;ETEC多重耐药率为17.56%(23/131),共有36种耐药谱型;EPEC多重耐药率为58.73%(37/63),共有42种耐药谱型;EAEC多重耐药率为44.74%(17/38),共有23种耐药谱型。 耐药率≥30%的抗菌药ETEC有萘啶酸(NAL)、氨苄西林(AMP), EPEC有AMP、四环素(TET)、复方新诺明(SXT)、磺胺异恶唑(Sul)、NAL,EAEC有NAL、AMP、SXT、Sul、TET。 2013 — 2016年与2017 — 2019年两个时间组试验抗菌药差异性比较发现:ETEC对AMP、头孢唑啉(CFZ)、TET、头孢吡肟(FEP)、氨曲南(AZM)、氨苄西林/舒巴坦(AMS)耐药水平上升,对Sul耐药水平下降;EPEC对庆大霉素(GEN)耐药水平下降;EAEC对头孢噻肟(CTX)、GEN、多西环素(DOX)耐药水平下降。  结论  北京市顺义区腹泻病例中,DEC具有较高的流行强度,ETEC、EPEC和EAEC的流行与耐药均具有较为独立的特征,耐药形势依然严峻;值得应引起公共卫生和临床部门的广泛关注。
    1)  王园园与林帆同为第一作者
  • 表  1  2013-2019年北京市顺义区腹泻病例中致泻性大肠埃希菌的年检出率分布

    Table  1.   Detection rates of DEC in diarrhea patients in Shunyi, 2013–2019

    年份致泻性大肠埃希菌总计
    肠产毒性大肠埃希菌肠致病性大肠埃希菌肠聚集性大肠埃希菌
    20139.642.411.2013.25
    20144.611.440.586.63
    20152.711.901.636.23
    20164.381.921.647.95
    20176.472.701.0810.24
    20185.882.671.349.89
    20195.295.013.3413.65
    合计5.412.601.579.57
      注:表内数据为检出率,即检出率(%)=阳性数/样本数×100
    下载: 导出CSV

    表  2  致泻性大肠埃希菌分离株的耐药状况分布

    Table  2.   Distribution of drug resistance of DEC isolates

    抗生素种类抗生素名称肠聚集性大肠埃希菌(n=38)肠致病性大肠埃希菌(n=63)肠产毒性大肠埃希菌(n=131)
    耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)
    β内酰胺类氨苄西林57.8960.5361.9061.9048.0948.85
    头孢唑林23.6836.8425.4036.5126.7237.40
    头孢噻肟10.5313.1622.2222.2225.1925.19
    头孢他啶2.632.631.596.351.532.29
    头孢吡肟a5.267.899.5215.871.539.92
    阿莫西林–克拉维酸a,b10.5321.053.1728.571.536.87
    亚胺培南0.000.001.593.170.000.00
    美罗培南0.000.000.000.000.000.76
    氨曲南2.637.899.5214.293.829.16
    氨苄西林–舒巴坦a18.4250.0019.0553.970.7627.48
    头霉素类头孢西丁a.b7.897.891.591.590.000.00
    氨基糖苷类链霉素15.7915.7920.6320.639.169.16
    庆大霉素a,b10.5315.7917.4625.402.293.05
    阿米卡星0.000.000.000.000.000.00
    卡那霉素0.000.001.591.590.760.76
    氟/奎诺酮类环丙沙星b2.632.639.5211.112.292.29
    左氧氟沙星a2.632.6311.1111.112.293.82
    萘啶酸60.5360.5341.2741.2757.2557.25
    四环素类四环素a,b42.1142.1150.7950.7914.5616.79
    米诺环素b0.007.893.1717.460.762.29
    多西环素a,b21.0534.2125.4044.441.539.16
    氯霉素类氯霉素a7.897.893.173.170.762.29
    磺胺类磺胺异恶唑a,b47.3747.3747.6247.6222.9022.90
    复方新诺明a,b52.6352.6349.2149.2124.4324.43
    脂肽类多粘菌素B0.000.001.591.590.760.76
    多粘菌素E0.000.001.591.590.760.76
      注:ETEC. 肠产毒性大肠埃希菌;EPEC. 肠致病性大肠埃希菌;EAEC. 肠聚集性大肠埃希菌;a. 耐药率差异有统计学意义;b. 非敏感率差异有统计学意义的抗菌药
    下载: 导出CSV

    表  3  不同年代致泻性大肠埃希菌分离株耐药状况分布

    Table  3.   Distribution of drug resistance of DEC in different years

    抗生素种类抗生素名称肠聚集性大肠埃希菌肠致病性大肠埃希菌肠产毒性大肠埃希菌
    2013-2016年(n=17)2017-2019年(n=21)2013-2016年(n=25)2017-2019年(n=35)2013-2015年(n=69)2017-2019年(n=65)
    耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)耐药率(%)非敏感率(%)
    β内酰胺类氨苄西林a,b58.8258.8257.1461.9072.0072.0054.2954.2930.4330.4366.1567.69
    头孢唑林a,b23.5323.5323.8147.6224.0024.0025.7142.8618.8421.7435.3855.38
    头孢噻肟e23.5323.530.004.7624.0024.0020.0020.0018.8418.8432.3132.31
    头孢他啶5.885.880.000.004.0012.000.002.860.000.003.084.62
    头孢吡肟b5.8811.760.000.0016.0024.008.5714.290.004.353.0815.38
    阿莫西林–克拉维酸5.8811.7614.2928.578.0024.000.0034.291.452.901.5410.77
    亚胺培南0.000.000.000.004.008.000.000.000.000.000.000.00
    美罗培南0.000.000.000.000.000.000.000.000.000.000.001.54
    氨曲南b5.8817.650.000.0012.0020.008.5711.431.451.456.1516.92
    氨苄西林–舒巴坦b11.7647.0623.8152.3820.0064.0017.1448.571.4515.941.5440.00
    头霉素类头孢西丁0.000.0014.2914.294.004.000.000.000.000.000.000.00
    氨基糖苷类链霉素17.6517.6514.2914.2928.0028.0017.1417.1410.1410.147.697.69
    庆大霉素c,d,e23.5335.290.000.0020.0040.0014.2914.291.451.454.626.15
    阿米卡星0.000.000.000.000.000.000.000.000.000.000.000.00
    卡那霉素0.000.000.000.004.004.000.000.000.000.001.541.54
    氟/奎诺酮类环丙沙星5.885.880.000.0012.0012.008.5711.430.000.004.624.62
    左氧氟沙星5.885.880.000.0012.0012.0011.4311.430.000.004.627.69
    萘啶酸58.8258.8261.9061.9048.0048.0037.1437.1452.1752.1761.5461.54
    四环素类四环素a,b58.8258.8228.5728.5764.0064.0042.8642.868.708.7021.5426.15
    米诺环素0.0011.760.004.760.0012.005.7122.860.000.001.544.62
    多西环素e35.2952.949.5219.0528.0048.0025.7142.861.455.801.5413.85
    氯霉素类氯霉素17.6517.650.000.004.004.002.862.860.001.451.543.08
    磺胺类磺胺异恶唑a47.0647.0647.6247.6264.0064.0040.0040.0031.8831.8812.3112.31
    复方新诺明47.0688.2457.1457.1460.0060.0042.8642.8630.4330.4318.4618.46
    脂肽类多粘菌素B0.000.000.000.000.000.002.862.860.000.001.541.54
    多粘菌素E0.000.000.000.000.000.002.862.860.000.001.541.54
      注:a. ETEC两个时间组耐药率差异有统计学意义;b. ETEC两个时间组非敏感率差异有统计学意义;c. EPEC两个时间组非敏感率差异有统计学意义;d. EAEC两个时间组耐药率差异有统计学意义;e. EAEC两个时间组非敏感率差异有统计学意义
    下载: 导出CSV

    表  4  肠产毒性大肠埃希菌排名前13位的耐药谱型及菌株分布

    Table  4.   Top 13 drug resistance spectrum types and strain distribution of ETEC

       耐药谱型耐药菌株数构成比(%)
    萘啶酸3627.48
    氨苄西林–萘啶酸1612.21
    全敏感1511.45
    氨苄西林–头孢西丁–头孢噻肟139.92
    氨苄西林–复方新诺明–磺胺异恶唑75.34
    氨苄西林–复方新诺明–头孢唑啉–头孢噻肟–磺胺异恶唑–链霉素53.82
    复方新诺明–磺胺异恶唑32.29
    四环素–复方新诺明-萘啶酸–磺胺异恶唑32.29
    四环素–萘啶酸21.53
    复方新诺明–萘啶酸–磺胺异恶唑21.53
    氨苄西林–四环素–萘啶酸21.53
    氨苄西林–复方新诺明–头孢唑啉–头孢噻肟–氨曲南21.53
    氨苄西林–四环–复方新诺明–头孢唑啉–头孢噻肟–萘啶酸21.53
    下载: 导出CSV
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  • 收稿日期:  2021-02-19
  • 网络出版日期:  2021-05-07

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