摘要
目的分析致血流与腹腔共同感染大肠埃希菌(CoECO)的表型和基因型特征,为经验性抗感染治疗提供线索。方法回顾性分析2010至2020年解放军总医院第一医学中心检验科自血液和腹腔标本中分离出的大肠埃希菌菌株。使用质谱鉴定仪鉴定菌种。使用全自动细菌鉴定药敏仪测定最小抑菌浓度。采用2×150 bp双末端测序策略对大肠埃希菌进行高通量测序。基因组序列经拼接后,使用kSNP3软件对菌株序列进行单核苷酸多态性(SNP)分析,以明确菌株间的同源关系;若分离自两部位的菌株具有较高同源关系,视为同一菌株,则该病例为CoECO感染病例。使用PubMLST网站确定多位点序列型(MLST),使用CARD网站筛选耐药基因。结果共筛选出70例CoECO感染病例,其中男45例,女25例,年龄(59.2±16.3)岁。每例CoECO感染病例选取1株大肠埃希菌进行后续分析,共计70株,分属于35种ST型,菌株数量较多的ST型包括:ST38(n=6)、ST405(n=6)、ST1193(n=6)、ST131(n=5),其他ST型所含菌株均少于5株。菌株间同源关系比较分散,整体呈现散发趋势,仅有个别菌株引起了小规模爆发。药敏结果显示:大肠埃希菌对氨苄西林的耐药率最高(91.4%,64/70),其次为氨苄西林/舒巴坦(74.3%,52/70)、头孢曲松(72.9%,51/70)、环丙沙星(71.4%,50/70)、左氧氟沙星(71.4%,50/70);对哌拉西林/他唑巴坦、碳青霉烯类和阿米卡星保持较高敏感性。耐药基因携带数量最多的是tet(A/B)(70.0%,49/70),其次分别为bla_(TEM)(58.6%,41/70)、sul1(55.7%,40/70)、sul2(54.3%,38/70)、bla_(CTX-M-14)(25.7%,18/70)、bla_(CTX-M-15)(17.1%,13/70)、bla_(CTX-M-55)(15.7%,11/70)、bla_(CTX-M-64/65)(5.7%,4/70)、bla_(CTX-M-27)(4.3%,3/70)、mcr-1(4.3%,3/70)、bla_(NDM-5)(2.9%,2/70)。结论CoECO整体呈散发分布,无明显优势克隆,未发现具有明显优势的基因型;菌株虽然对部分抗菌药物耐药率较高,但携带耐药基因比例较低,对部分一线抗菌药物有较高敏感�
Objective To analyze the phenotypic and genotypic characteristics of Escherichia coli causing bloodstream and abdominal co-infection(CoECO),and provide clues for empirical antibiotics treatment.Methods The strains of Escherichiacoli isolated from blood and abdominal samples in the Department of Laboratory Medicine of the First Medical Center of the PLA General Hospital from 2010 to 2020 were retrospectively analyzed.Mass spectrometer was used to identify all of the strains and the minimum inhibitory concentration(MIC)were detected by VITEK 2 Compact.All isolates were sequenced by 2×150 bp double terminal sequencing strategy on the HiSeq X Ten sequencer(Illumina).After the genome sequence was spliced,the single nucleotide polymorphism(SNP)analysis of the strain sequence was performed using kSNP3 software to clarify the homologous relationship between strains.If the strains isolated from two different parts had high homology,they were regarded as the same strain and the case was with CoECO infection.Meanwhile,the multilocus sequence type(MLST)was determined using PubMLST website and resistant genes were screened by CARD website.Results A total of 70 cases of CoECO infection were screened,including 45 males and 25 females,and aged(59.2±16.3)years old.The 70 CoECO isolates belonged to 35 sequence types(STs).The most prevalent STs included ST38(n=6),ST 405(n=6),ST 1193(n=6)and ST131(n=5),and other ST types contained less than 5 strains.The homologous relationship among strains was relatively scattered,presenting a sporadic trend as a whole,and only a few strains had a small-scale outbreak.The CoECO isolates showed significantly resistance to ampicillin(91.4%,64/70),ampicillin/sulbactam(74.3%,52/70),ceftriaxone(72.9%,51/70),ciprofloxacin(71.4%,50/70)and levofloxacin(71.4%,50/70),and high-sensitivity to piperacillin/tazobactam,carbapenems and amikacin.The most prevalent resistant gene was tet(A/B)(70%,49/70),followed by bla_(TEM)(58.6%,41/70),sul1(55.7%,40/70),sul2(54.3%,38/70),bla_(CTX-M-14)(25.7%,18/70),bla_(CTX-M-1
作者
宫天野
郭玲
叶坤
赵强
叶丽艳
马艳宁
王丽凤
杨继勇
Gong Tianye;Guo Ling;Ye Kun;Zhao Qiang;Ye Liyan;Ma Yanning;Wang Lifeng;Yang Jiyong(Department of Laboratory Medicine,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Graduate School,Medical School of Chinese PLA,Beijing 100039,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第13期986-990,共5页
National Medical Journal of China
关键词
血流感染
腹腔感染
大肠埃希菌
高通量测序
多位点序列分型
横断面研究
Bloodstream infection
Abdominal infection
Escherichia coli
Next-generation Sequencing
Multilocus sequence type
Cross-sectional study
