CAJ | 학술논문

目的了解引起老年患者泌尿系统感染大肠埃希菌的30种毒力因子与4种常用抗菌药物(左氧氟沙星、庆大霉素、头孢吡肟和哌拉西林/他唑巴坦)耐药性之间的关系.方法收集2009年至2011年天津市三家综合性医院泌尿系统院内感染老年患者尿液标本分离的133株大肠埃希菌,采用K-B纸片扩散法检测菌株的药物敏感性,以多重PCR检测133株大肠埃希菌中的30种毒力因子.应用R×C表资料的双侧；x2检验对药物敏感结果进行分析,Logistic回归分析毒力因子与抗菌药物耐药性之间的相关性.结果分离的133株大肠埃希菌对左氧氟沙星耐药率最高,为72株,占54.1％,最低的为哌拉西林/他唑巴坦20株,占15.0％(x2 =51.57,P＜0.01).引起老年性泌尿系统感染大肠埃希菌中,毒力因子fimH检出率最高,为79.7％.30种毒力因子与4种常用抗菌药物之间,pa pC、sfaS、pagG alleleⅡ、papA、papEF、sfa/ focDE、hlyA、rfc、cnf1等毒力因子在左氧氟沙星敏感组中多见(P值分别=0.004、0.029、0.001、0.031、0.007、0.001、0.006、0.010和0.013);iutA,kpsMTⅢ和cva等毒力因子在庆大霉素耐药组中多见(P值分别=0.003、0.010和0.000)；sfa/focDE和K1等毒力因子在庆大霉素敏感组中多见(P值分别=0.007和0.050),kpsMTⅢ在头孢吡肟耐药组中多见(P=0.024),cnf1在头孢吡肟敏感组中更多见(P=0.014)；traT在哌拉西林/他唑巴坦耐药组中多见(P=0.026),kpsMTⅡ在哌拉西林/他唑巴坦敏感组中多见(P=0.024).结论引起老年性泌尿系统感染的大肠埃希菌同时携带多种毒力因子,大肠埃希菌耐药性与其所携带的毒力因子有关,应引起临床重视.
목적 료해인기노년환자비뇨계통감염대장애희균적30충독력인자여4충상용항균약물(좌양불사성、경대매소、두포필우화고랍서림/타서파탄)내약성지간적관계.방법 수집2009년지2011년천진시삼가종합성의원비뇨계통원내감염노년환자뇨액표본분리적133주대장애희균,채용K-B지편확산법검측균주적약물민감성,이다중PCR검측133주대장애희균중적30충독력인자.응용R×C표자료적쌍측；x2검험대약물민감결과진행분석,Logistic회귀분석독력인자여항균약물내약성지간적상관성.결과 분리적133주대장애희균대좌양불사성내약솔최고,위72주,점54.1％,최저적위고랍서림/타서파탄20주,점15.0％(x2 =51.57,P＜0.01).인기노년성비뇨계통감염대장애희균중,독력인자fimH검출솔최고,위79.7％.30충독력인자여4충상용항균약물지간,pa pC、sfaS、pagG alleleⅡ、papA、papEF、sfa/ focDE、hlyA、rfc、cnf1등독력인자재좌양불사성민감조중다견(P치분별=0.004、0.029、0.001、0.031、0.007、0.001、0.006、0.010화0.013);iutA,kpsMTⅢ화cva등독력인자재경대매소내약조중다견(P치분별=0.003、0.010화0.000)；sfa/focDE화K1등독력인자재경대매소민감조중다견(P치분별=0.007화0.050),kpsMTⅢ재두포필우내약조중다견(P=0.024),cnf1재두포필우민감조중경다견(P=0.014)；traT재고랍서림/타서파탄내약조중다견(P=0.026),kpsMTⅡ재고랍서림/타서파탄민감조중다견(P=0.024).결론 인기노년성비뇨계통감염적대장애희균동시휴대다충독력인자,대장애희균내약성여기소휴대적독력인자유관,응인기림상중시.
Objective To understand the relationship between thirty virulence factors (VF) and drug resistance of four commonly used antibiotics (levofloxacin,gentamycin,cefepime,and piperacillin/tazobactam) against Escherichia coli in senile urinary tract infection.Methods A total of 133 Escherichia coli clinical isolates from senile patients with urinary tract infection were collected in three general hospitals during 2009 to 2011.The drug sensitivity was detected using disk diffusion assay.Multiplex polymerase chain reaction (mPCR) method was employed to screen 30 virulence factors of the 133 isolates of Escherichia coli.The date of susceptibility frequencies were determined by using two-tailed-Chi-square exact test.Logistic exact test was used to evaluated the correlation between the virulence factors and antibiotic resistances.Results Among all isolates,levofloxacin resistance rate was the highest 54.1％,piperacillin/tazobactam resistance rate was the lowest 15.0 ％ (x2=51.57,P＜0.01).The positive rate of virulence gene fimH was the highest (79.7％) in Escherichia coli causing senile urinary tract infection.papC,sfaS,pagG allele Ⅱ,papA,papEF,sfa/focDE,hlyA,rfc,cnf1 of VF were associated with levofloxacin-susceptibility (P =0.004,0.029,0.001,0.031,0.007,0.001,0.006,0.010 and 0.013,respectively) ; iutA,kpsMT Ⅲ and cva were linked to gentamycin-resistance (P=0.003,0.010 and 0.000,respectively) ; sfa/focDE and K1 were associated with gentamycin-susceptibility (P=0.007 and 0.050,respectively) ; kpsMT Ⅲ was associated with cefepime-resistance (P =0.024); cnf1 was associated with cefepimesusceptibility (P=0.014) ; traT was associated with piperacillin/tazobactam-resistance (P =0.026) ;kpsMT Ⅱ was associated with piperacillin/tazobactam-susceptibility (P =0.024).Conclusions Escherichia coli strains caused senile urinary tract infections carry a variety of VF.The antimicrobial resistance of Escherichia coli is associated with the VF,which needs to be paid attention in the clinical practice.