摘要
目的 分析骨髓异常综合征(MDS)合并肺炎克雷伯菌(KPN)、大肠埃希菌(ECO)血流感染患者产超广谱β内酰胺酶(ESBL)菌流行特点及危险因素。方法 选取2017年7月-2020年7月山西省运城市中心医院65例MDS合并KPN、ECO血流感染患者,收集其分离菌,经双纸片扩散法检测ESBL表型,PCR法明确基因型,多位点序列分型(MLST)分析ESBL阳性菌株同源性,并开展体外药物敏感试验,分析产ESBL菌检出的危险因素。结果 65例MDS患者分离出菌株65株,其中KPN 11株(16.92%),ECO 54株(83.08%),产ESBL菌检出率为33.85%(22/65),其中KPN、ECO的ESBL分离率分别为18.18%、37.04%,产ESBL菌株中CTX-M型占95.45%,以CTX-M-14型(27.27%)、CTX-M-55型(18.18%)最常见,MLST结果发现,产ESBL ECO共13种ST型,以ST131型为主,占25.00%,2株产ESBL的KPN均为ST23型;22株ESBL菌株对阿米卡星、磷霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦敏感率均>90%,对碳青霉烯类药物均敏感;慢性肺部感染、感染前30 d使用头孢菌素为MDS合并KPN与ECO血流感染患者产ESBL菌检出的危险因素(P<0.05)。结论 MDS合并KPN、ECO血流感染患者产ESBL菌检出率高,基因型以CTX-M型为主,ST型以ST131为主,慢性肺部感染、感染前30 d使用头孢菌素可能是产ESBL菌检出的危险因素。
OBJECTIVE To investigate the characteristics of prevalence of extended-spectrum beta-lactamases(ESBLs)-producing strains among myelodysplastic syndrome(MDS) patients complicated with Klebsiella pneumoniae(KPN) and Escherichia coli(ECO) bloodstream infections. METHODS A total of 65 MDS patients complicated with KPN, ECO bloodstream infection who were treated in the Yuncheng Central Hospital from Jul 2017 to Jul 2020 were enrolled in the study. The isolated strains were collected, the phenotype of ESBL were detected by double-disc diffusion method, the genotypes were determined by PCR, the homology of the ESBL-positive strains was analyzed by means of multilocus sequence typing(MLST), the in vitro drug susceptibility testing was performed, and the risk factors for isolation of ESBL-producing strains were analyzed. RESULTS Totally 65 strains were isolated from the 65 MDS patients, 11(16.92%) of which were KPN, 54(83.08%) were ECO, and the isolation rate of ESBL-producing strains was 33.85%(22/65), the isolation rates of ESBL-producing KPN and ECO strains were respectively 18.18% and 37.04%. Among the ESBL-producing strains, CTX-M accounted for 95.45%, CTX-M-14(27.27%) and CTX-M-55(18.18%) were most common. The result of MLST showed that there were 13 ST types among the ESBL-producing ECO strains, ST131 was dominant, accounting for 25.00%;2 of ESBL-producing KPN were ST23. The drug susceptibility rates of the 22 ESBL-producing strains to amikacin, fosfomycin, piperacillin-tazobactam and cefoperazone-sulbactam were more than 90%, and all of the strains were sensitive to carbapenems. Chronic pulmonary infection and use of cephalosporins 30 days before infection were risk factors for the isolation of ESBL-producing strains from the MDS patients complicated with KPN and ECO bloodstream infection(P<0.05). CONCLUSION The isolation rate of ESBL-producing strains is high among the MDS patients complicated with KPN and ECO bloodstream infection. CTX-M is the predominant genotype, ST131 is dominant among ST types. The chronic
作者
陶永明
李乐
赵秋霞
裴军芳
张林渊
TAO Yong-ming;LI Le;ZHAO Qiu-xia;PEI Jun-fang;ZHANG Lin-yuan(Yuncheng Central Hospital,Yuncheng,Shanci 04000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第10期1454-1458,共5页
Chinese Journal of Nosocomiology
基金
山西省科研基金资助项目(20219-211)。
关键词
骨髓异常综合征
肺炎克雷伯菌
大肠埃希菌
血流感染
超广谱Β内酰胺酶
流行特点
危险因素
Myelodysplastic syndrome
Klebsiella pneumoniae
Escherichia coli
Bloodstream infection
Extended-spectrum beta-lactamase
Prevalence characteristic
Risk factor
