2015―2019年安徽省致泻性大肠埃希菌分型及耐药性分析

李春; 陈国平; 孟昭倩; 王利; 陈晴晴; 孙永; 张竹慧

doi:10.16462/j.cnki.zhjbkz.2020.10.009

2015―2019年安徽省致泻性大肠埃希菌分型及耐药性分析

doi: 10.16462/j.cnki.zhjbkz.2020.10.009

李春^1, ,,
陈国平²,
孟昭倩³,
王利⁴,
陈晴晴¹,
孙永¹,
张竹慧¹

1.
230601 合肥, 安徽省疾病预防控制中心微生物检验室
2.
230601 合肥, 安徽省疾病预防控制中心食品营养与学校卫生科
3.
236000 阜阳, 阜阳市疾病预防控制中心检验科
4.
243000 马鞍山, 马鞍山市疾病预防控制中心检验科

基金项目:

国家科技重大专项 2018ZX10713003-002-005

详细信息

通讯作者:
李春, E-mail:lichun0218@126.com

中图分类号: R378.21
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出版历程
- 收稿日期: 2020-03-24
- 修回日期: 2020-05-28
- 刊出日期: 2020-10-10

Typing and antimicrobial resistance analysis of diarrheogenic Escherichia coli in Anhui Province from 2015 to 2019

1.
Microbiological laboratory of Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
2.
Department of Food Nutrition and School Health, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
3.
Department of Laboratory of Fuyang Provincial Center for Disease Control and Prevention, Fuyang 236000, China
4.
Department of Laboratory of Maanshan Provincial Center for Disease Control and Prevention, Maanshan 243000, China

Funds:

The National Sci-Tech Key Project 2018ZX10713003-002-005

More Information

Corresponding author: LI Chun,E-mail:lichun0218@126.com

摘要

摘要: 目的了解安徽省致泻性大肠埃希菌（DEC）的菌群流行特点及耐药趋势，为安徽省DEC腹泻病的诊断和治疗提供科学依据。方法采集安徽省2015―2019年腹泻患者粪便样本，采用多重实时荧光定量PCR对细菌进行鉴定与分型，采用微量肉汤稀释法对细菌进行药敏试验。结果从6 120份粪便中分离出DEC 557株，主要病原型为：非典型肠聚集性大肠埃希菌（aEAEC）191（34.29%）株，产肠毒素性大肠埃希菌（ETEC）153（27.47%）株，非典型肠致病性大肠埃希菌（aEPEC）108（19.39%）株，典型肠聚集性大肠埃希菌（tEAEC）77（13.82%）株，肠侵袭性大肠埃希菌（EIEC）11（1.97%）株，典型肠致病性大肠埃希菌（tEPEC）3（0.54%）株。药敏检测多重耐药255（45.78%）株；同种病理类型不同年份耐药性存在差异：aEAEC：氨苄西林/舒巴坦（AMS），萘啶酸（NAL），头孢西林（CFZ）；tEAEC：AMS，CFZ，阿奇霉素（AZM）；EPEC（aEPEC，tEPEC）：氨苄西林（AMP），AMS，CFZ；ETEC：NAL，AZM，环丙沙星（CIP）。不同病理类型耐药性存在差异的抗生素有：AMP，AMS，四环素（TET），NAL，红霉素（ERY），氯霉素（CHL），头孢噻肟（CTX），CFZ，庆大霉素（GEN），甲氧苄啶/磺胺甲恶唑（SXT），AZM和CIP。2015―2019年，tEAEC对CFZ，EPEC对AMP，AMS和CFZ，ETEC对NAL和CIP，耐药性呈增强趋势。结论本地区DEC流行的主要型别是：aEAEC、ETEC、aEPEC和tEAEC。DEC的耐药情况较严重，常用抗生素AMP、AMS、NAL、CFZ和CIP在不同年份和不同病理类型间，耐药性差异明显，耐药性分析结果为临床合理使用抗生素，遏制抗菌药物耐药性增加提供参考。
- 致泻性大肠埃希菌 /
- 分型 /
- 耐药性
Abstract: Objective To understand the epidemic characteristics and drug resistance trend of diarrheogenic Escherichia coli (DEC) in Anhui area, so as to provide an important basis for prevention and treatment of DEC diarrhea in Anhui Province. Methods Fecal samples of diarrhea patients were collected and inoculated with McConkey culture medium in Anhui from 2015 to 2019. Suspicious colonies were identified and typed by multiple fluorescence quantitative PCR, and drug sensitivity test was carried out by microbroth dilution method. Results 557 strains were isolated from 6 120 stool samples. The main pathotypes were 191(34.29%) a typical enteroaggregative Escherichia coli (aEAEC), 153(27.47%) enterotoxigenic Escherichia coli (ETEC), 108(19.39%) a typical enteropathogenic Escherichia coli (aEPEC), 77(13.82%) typical enteroaggregative Escherichia coli (tEAEC), 11(1.97%) enteroinvasive Escherichia coli (EIEC) and 3(0.54%) typical enteropathogenic Escherichia coli (tEPEC). Multidrug resistant bacteria accounted for 45.78%. The statistically significant resistance difference of the same pathotype in different years were as follows:a typical EAEC:ampicillin/sulbactam (AMS), nalidixic acid (NAL), cefoxicillin (CFZ); typical EAEC:AMS, CFZ, azithromycin (AZM); EPEC:ampicillin (AMP), AMS, CFZ; ETEC:NAL, AZM, ciprofloxacin (CIP). The antibiotics with statistically significant differences in drug resistance among different pathotypes were AMP, AMS, tetracycline(TET), NAL, erythromycin (ERY), chloramphenicol (CHL), cefotaxime (CTX), CFZ, gentamicin (GEN), trimethoprim/sulfamethoxazole (SXT), AZM and CIP. The resistance of tEAEC to CFZ, EPEC to AMP, AMS and CFZ, ETEC to NAL and CIP showed an increasing trend from 2015 to 2019. Conclusions The mainly epidemic pathotypes in Anhui area were aEAEC, ETEC, aEPEC and tEAEC. The resistances of antibiotics (AMP, AMS, NAL, CFZ and CIP) were significantly different among different years and pathotypes. The results of resistance analysis can provide reference for rational use of antibiotics and prevention of the increase of antimicrobial resistance.
- Diarrheogenic Escherichia coli /
- Pathotypes /
- Resistance

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图 1 2015―2019年安徽省557例致泻性大肠埃希菌引起急性胃肠炎的发病时间分布图

注：aEPEC：非典型肠致病性大肠埃希菌；tEAEC：典型肠聚集性大肠埃希菌；aEAEC：非典型肠聚集性大肠埃希菌；ETEC：产肠毒素性大肠埃希菌；tEPEC：典型肠致病性大肠埃希菌；EIEC：肠侵袭性大肠埃希菌。

Figure 1. Time distribution of 557 cases of acute gastroenteritis caused by diarrhea Escherichia coli

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表 1 2015―2019年安徽省557株致泻性大肠埃希氏菌的药敏检测结果

Table 1. Drug sensitivity results of 557 strains of diarrhea Escherichia coli in Anhui Province from 2015 to 2019

抗生素名称	耐药		中介		敏感
抗生素名称	菌株数	百分率(%)	菌株数	百分率(%)	菌株数	百分率(%)
AMP	399	71.63	6	1.08	152	27.29
CAZ	44	7.90	27	4.84	486	87.26
AMS	129	23.16	163	29.26	265	47.58
IPM	7	1.26	3	0.54	547	98.20
TET	303	54.40	5	0.90	249	44.70
NAL	318	57.09	-	-	239	42.91
ERY	538	96.59	14	2.51	5	0.90
CFX	43	7.72	23	4.13	491	88.15
CHL	98	17.59	25	4.49	434	77.92
CTX	188	33.75	12	2.15	357	64.10
CFZ	230	41.29	110	19.75	217	38.96
GEN	143	25.67	13	2.33	401	72.00
SXT	270	48.47	-	-	287	51.53
AZM	149	26.75	-	-	408	73.25
CIP	79	14.18	12	2.16	466	83.66
注：AMP：氨苄西林；CAZ：头孢他啶；AMS：氨苄西林/舒巴坦；IPM：亚胺培南；TET：四环素；NAL：萘啶酸；ERY：红霉素；CFX：头孢西丁；CHL：氯霉素；CTX：头孢噻肟；CFZ：头孢唑啉；GEN：庆大霉素；SXT：甲氧苄啶/磺胺甲恶唑；AZM：阿奇霉素；CIP：环丙沙星。

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表 2 安徽省同种病理类型DEC耐药性在2015―2019年间存在差异的结果[n(%)]

Table 2. Resistance difference of the same pathotype in Anhui Province from 2015 to 2019 [n(%)]

药敏结果	2015年	2016年	2017年	2018年	2019年	χ²值	P值
aEAEC
AMS						24.626	0.002
R	5(13.16)	23(47.92)	10(31.25)	9(21.95)	11(34.38)
I	8(21.05)	10(20.83)	8(25.00)	17(41.46)	13(40.62)
S	25(65.79)	15(31.25)	14(43.75)	15(36.59)	8(25.00)
NAL						10.074	0.039
R	24(63.16)	26(54.17)	27(84.38)	27(65.85)	25(78.13)
S	14(36.84)	22(45.83)	5(15.62)	14(34.15)	7(21.87)
CFZ						17.501	0.025
R	18(47.37)	24(50.00)	19(59.38)	17(41.46)	21(65.63)
I	2(5.26)	13(27.08)	2(6.25)	9(21.95)	4(12.50)
S	18(47.37)	11(22.92)	11(34.37)	15(36.59)	7(21.87)
tEAEC
AMS						17.049	0.030
R	0(0.00)	8(50.00)	3(20.00)	8(42.11)	6(31.58)
I	1(12.5)	4(25.00)	7(46.67)	5(26.32)	9(47.37)
S	7(87.50)	4(25.00)	5(33.33)	6(31.57)	4(21.05)
CFZ						22.150	0.005
R	3(37.50)	2(12.50)	5(33.33)	12(63.16)	11(57.89)
I	0(0.00)	9(56.25)	4(26.67)	1(5.26)	5(26.32)
S	5(62.50)	5(31.25)	6(40.00)	6(31.58)	3(15.79)
AZM						13.940	0.007
R	4(50.00)	5(31.25)	1(6.67)	11(57.89)	3(15.79)
S	4(50.00)	11(68.75)	14(93.33)	8(42.11)	16(84.21)
EPEC
AMP						13.209	0.010
R	15(53.57)	9(33.33)	9(64.29)	13(81.25)	19(73.08)
I	0(0.00)	0(0.00)	0(0.00)	0(0.00)	0(0.00)
S	13(46.43)	18(66.67)	5(35.71)	3(18.75)	7(26.92)
AMS						23.583	0.003
R	1(3.57)	6(22.22)	1(7.14)	6(37.50)	6(23.08)
I	3(10.71)	3(11.11)	7(50.00)	5(31.25)	7(26.92)
S	24(85.72)	18(66.67)	6(42.86)	5(31.25)	13(50.00)
CFZ						32.965	＜0.001
R	6(21.43)	5(18.52)	6(42.86)	9(56.25)	4(15.38)
I	0(0.00)	5(18.52)	0(0.00)	4(25.00)	11(42.31)
S	22(78.57)	17(62.96)	8(57.14)	3(18.7)	11(42.31)
ETEC
NAL						17.268	0.002
R	14(42.42)	14(42.42)	11(57.89)	46(75.41)	21(75.00)
S	19(57.58)	19(57.58)	8(42.11)	15(24.59)	7(25.00)
AZM						23.808	＜0.001
R	3(9.09)	3(9.09)	4(21.05)	24(39.34)	1(3.57)
S	30(90.91)	30(90.91)	15(78.95)	37(60.66)	27(96.43)
CIP						23.364	0.003
R	0(0.00)	0(0.00)	3(15.79)	0(0.00)	4(14.29)
I	0(0.00)	0(0.00)	0(0.00)	2(3.28)	0(0.00)
S	33(100)	33(100)	16(84.21)	59(96.72)	24(85.71)
注：R：耐药；I：中介；S：敏感；aEAEC：非典型肠聚集性大肠埃希菌；tEAEC：典型肠聚集性大肠埃希菌；EPEC：肠致病性大肠埃希菌；ETEC：产肠毒素性大肠埃希菌；AMS：氨苄西林/舒巴坦；NAL：萘啶酸；CFZ：头孢唑啉；AZM：阿奇霉素；AMP：氨苄西林；CIP：环丙沙星

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表 3 2015―2019年安徽省不同病理类型DEC耐药性存在差异的结果[n(%)]

Table 3. Resistance difference of different pathotypes in Anhui Province from 2015 to 2019 [n(%)]

药敏结果	aEAEC	tEAEC	EPEC (aEPEC, tEPEC)	ETEC	EIEC	χ²值	P值
AMP						32.115	＜0.001
R	149(78.01)	66(85.71)	65(58.56)	100(65.36)	11(72.73)
I	1(0.52)	0(0.00)	0(0.00)	5(3.27)	0(0.00)
S	41(21.47)	11(14.29)	46(41.44)	48(31.37)	3(27.27)
AMS						35.558	＜0.001
R	58(30.37)	25(32.47)	20(18.02)	16(10.46)	3(27.27)
I	56(29.32)	26(33.77)	25(22.52)	52(33.99)	1(9.09)
S	77(40.31)	26(33.76)	66(59.46)	85(55.56)	7(63.64)
TET						39.860	＜0.001
R	127(66.49)	42(54.55)	65(58.56)	52(33.99)	7(63.64)
I	0(0.00)	1(1.30)	1(0.90)	3(1.96)	0(0.00)
S	64(33.51)	34(44.15)	45(40.54)	98(64.05)	4(36.36)
NAL						45.207	＜0.001
R	129(67.54)	34(44.16)	36(32.43)	100(65.36)	6(54.55)
S	62(32.46)	43(55.84)	75(67.57)	53(34.64)	5(45.45)
ERY						22.707	0.004
R	187(97.91)	75(97.40)	110(99.10)	144(94.12)	9(81.82)
I	4(2.09)	2(2.60)	1(0.90)	5(3.27)	2(18.18)
S	0(0.00)	0(0.00)	0(0.00)	4(2.61)	0(0.00)
CHL						39.536	＜0.001
R	52(27.23)	8(10.39)	21(18.92)	10(6.54)	3(27.27)
I	5(2.62)	9(11.69)	3(2.70)	7(4.57)	1(9.09)
S	134(70.15)	60(77.92)	87(78.38)	136(88.89)	7(63.64)
CTX						27.725	0.001
R	85(44.50)	26(33.77)	22(19.82)	42(27.45)	7(63.64)
I	4(2.10)	1(1.30)	4(3.60)	3(1.96)	0(0.00)
S	102(53.40)	50(64.93)	85(76.58)	108(70.59)	4(36.36)
CFZ						30.436	＜0.001
R	99(51.83)	33(42.86)	30(27.03)	54(35.29)	7(63.64)
I	30(15.7)	19(2.68)	20(18.02)	38(24.84)	0(0.00)
S	62(32.46)	25(32.46)	61(54.95)	61(39.87)	4(36.36)
GEN						51.336	＜0.001
R	73(38.22)	26(33.77)	28(25.23)	9(5.88)	4(36.36)
I	5(2.62)	1(1.30)	2(1.80)	4(2.61)	0(0.00)
S	113(59.16)	50(64.94)	81(72.97)	140(91.50)	7(63.64)
SXT						74.453	＜0.001
R	126(65.97)	49(63.64)	45(40.54)	35(22.88)	7(63.64)
S	65(34.03)	28(36.36)	66(59.46)	118(77.12)	4(36.36)
AZM						12.771	0.012
R	64(33.51)	24(31.17)	20(18.02)	32(20.92)	4(36.36)
S	127(66.49)	53(68.83)	91(81.98)	121(79.08)	7(63.64)
CIP						58.970	＜0.001
R	52(27.23)	4(5.19)	9(8.11)	7(4.57)	4(36.36)
I	3(1.57)	5(6.49)	2(1.80)	2(1.31)	0(0.00)
S	136(71.20)	68(88.31)	100(90.09)	144(94.12)	7(63.64)
注：R：耐药；I：中介；S：敏感；AMP：氨苄西林；CAZ：头孢他啶；AMS：氨苄西林/舒巴坦；IPM：亚胺培南；TET：四环素；NAL：萘啶酸；ERY：红霉素；CFX：头孢西丁；CHL：氯霉素；CTX：头孢噻肟；CFZ：头孢唑啉；GEN：庆大霉素；SXT：甲氧苄啶/磺胺甲恶唑；AZM：阿奇霉素；CIP：环丙沙星；aEAEC：非典型肠聚集性大肠埃希菌；tEAEC：典型肠聚集性大肠埃希菌；aEPEC：非典型肠致病性大肠埃希菌；tEPEC：典型肠致病性大肠埃希菌；ETEC：产肠毒素性大肠埃希菌；EIEC：肠侵袭性大肠埃希菌。

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