CAJ | 학술논문

目的：了解肿瘤专科医院临床和环境标本中产超广谱β‐内酰胺酶（ESBL ）大肠埃希菌的基因型及同源性。方法检测2012年6月至2013年1月郑州大学附属肿瘤医院住院患者的临床标本（血液、尿液、痰液、胸腔积液、腹腔积液、引流液、粪便等）和环境标本（空气、陪护者手、门把手、床扶手、床头柜、医护人员手）中产 ESBL 大肠埃希菌，经表型确认试验确定 ESBL 的表型，多重 PCR检测blaTEM 、blaSHV 、blaOXA 、blaCTX和blaFOX等基因型，脉冲场凝胶电泳（PFGE）分析临床标本和环境标本中菌株的同源性。结果表型确认试验检测到临床标本和环境标本中共有产ESBL大肠埃希菌41株，其中临床标本中有36株（为28例患者的临床标本），环境标本中有5株。多重PCR检测ESBL基因，单一型别ESBL菌株以携带 TEM‐1基因型和 CTX‐14基因型为主；两种型别 ESBL 菌株以携带 CTX‐14、TEM‐1基因型为主；三种型别ESBL菌株同时携带CTX‐14、TEM‐1和SHV‐1基因型。PFGE结果显示，28例患者的粪便和其他临床标本中产ESBL大肠埃希菌之间没有同源性，外科一病区3例患者及其中1例患者的床头柜上检出产ESBL大肠埃希菌有同源性。结论郑州大学附属肿瘤医院产 ESBL大肠埃希菌主要流行的基因型为TEM‐1、CTX‐14、CTX‐1。同一菌株可具有多种基因型别，以两种型别为主。外源性感染是产ESBL大肠埃希菌感染途径之一。
목적：료해종류전과의원림상화배경표본중산초엄보β‐내선알매（ESBL ）대장애희균적기인형급동원성。방법검측2012년6월지2013년1월정주대학부속종류의원주원환자적림상표본（혈액、뇨액、담액、흉강적액、복강적액、인류액、분편등）화배경표본（공기、배호자수、문파수、상부수、상두거、의호인원수）중산 ESBL 대장애희균，경표형학인시험학정 ESBL 적표형，다중 PCR검측blaTEM 、blaSHV 、blaOXA 、blaCTX화blaFOX등기인형，맥충장응효전영（PFGE）분석림상표본화배경표본중균주적동원성。결과표형학인시험검측도림상표본화배경표본중공유산ESBL대장애희균41주，기중림상표본중유36주（위28례환자적림상표본），배경표본중유5주。다중PCR검측ESBL기인，단일형별ESBL균주이휴대 TEM‐1기인형화 CTX‐14기인형위주；량충형별 ESBL 균주이휴대 CTX‐14、TEM‐1기인형위주；삼충형별ESBL균주동시휴대CTX‐14、TEM‐1화SHV‐1기인형。PFGE결과현시，28례환자적분편화기타림상표본중산ESBL대장애희균지간몰유동원성，외과일병구3례환자급기중1례환자적상두거상검출산ESBL대장애희균유동원성。결론정주대학부속종류의원산 ESBL대장애희균주요류행적기인형위TEM‐1、CTX‐14、CTX‐1。동일균주가구유다충기인형별，이량충형별위주。외원성감염시산ESBL대장애희균감염도경지일。
Objective To analyze the genotypes of extended‐spectrum β‐Lactamases (ESBL )‐producing Escherichia coli (E .coli) and its homology from the clinical and environmental samples at the tumor hospital . Methods The clinical samples (including the patient′s blood , urine , sputum , hydrothorax ,drainage fluid ,stool ,etc) and environmental samples (including the air ,escort hand ,door handles ,bed rails ,bedside table ,medical staff hand) were collected at the Tumor Hospital Affiliated to Zhengzhou University from June 2012 to January 2013 .The confirmatory test of ESBL phenotype was performed .β‐Lactamase genes (blaTEM , blaSHV , blaOXA , blaCTX and blaFOX) were detected by multiplex polymerase chain reaction (PCR) assays .Pulsed‐field gel electrophoresis (PFGE) was used to characterize the homology of all the strains .Results The phenotypic confirmatory test detected a total of 41 ESBL‐producing E .coli ,among which 36 stains were from clinical specimens (all were from 28 patients) and 5 strains from environmental specimens . Meanwhile , multiplex PCR detection of the genes of ESBL‐producing E .coli was performed .TEM‐1 or CTX‐14 type was predominant in ESBL‐producing E .coli carrying one gene .Those carrying two genes were mainly CTX‐14 and TEM‐1 genes ,whereas three genes were CTX‐14 ,TEM‐1 and SHV‐1 .PFGE results showed that the specimens from 28 patients that located in gut or other clinical specimens shared no homology in ESBL‐producing E . coli . However , the specimens from 3 patients and 1 patient′s bedside table in the first surgical ward shared homology . The major epidemic genes of E .coli in our hospital were TEM‐1 ,CTX‐14 and CTX‐1 .The same strain may have many genotypes ,mainly with two genes .Exogenous infection may be one major way in ESBL‐producing E .coli infection .