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目的回顾性分析社区尿液分离大肠埃希菌喹诺酮类抗菌药物耐药机制,为临床抗感染治疗提供参考。方法收集2013年6月-2015年6月门诊就诊患者尿液标本中分离的环丙沙星耐药大肠埃希菌,经VITEK 2全自动鉴定药敏仪进行鉴定和药敏分析,PCR检测质粒介导喹诺酮耐药基因qnr A、qnr B、qnr C、qnr D、qnr S、aac(6’)-Ib-cr、qep A、oqx A、oqx B,同时测序分析喹诺酮耐药决定区gyrA、gyrB、parC、parE突变情况。结果共分离到大肠埃希菌131株,其中环丙沙星耐药56株,耐药率为42.7%,qnr S检出1株(1.7%)、oqx A及oqx B阳性各4株(7.1%)、aac(6’)-Ib-cr阳性26株(46.4%)、qnr A阳性10株(17.9%)、qnr B阳性3株(5.4%),未检出qnr C、qnr D、qep A。此外,gyrA基因发生Ser83→Leu突变3株(5.4%)、gyrB发生基因Asp87→Leu突变3株(5.4%);parC基因发生Ser80→Ile突变2株(3.6%)。结论门诊患者尿液分离大肠埃希菌喹诺酮类耐药机制以质粒介导为主,尤其是aac(6’)-Ib-cr耐药基因。由于质粒介导喹诺酮耐药基因易在不同菌株中播散,应加强监测。
Objective To retrospectively analyze the mechanism of resistance to quinolone antibiotics in Escherichia coli isolated from urine in community and provide references for clinical anti-infection treatment. Methods Ciprofloxacin-resistant Escherichia coli isolated from urine samples from outpatients during June 2013 to June 2015 were collected and identified by VITEK 2 automatic identification instrument and drug susceptibility analysis. Plasmids were detected by PCR The quinolone resistance genes qrr, qnr B, qnr C, qnr D, qnr S, aac (6 ’) - Ib-cr, qep A, oqx A and oqx B were also detected. gyrB, parC, parE mutations. Results A total of 131 strains of Escherichia coli were isolated, of which 56 were resistant to ciprofloxacin, with a resistance rate of 42.7%, 1 strain of qnr S (1.7%), 4 of oqx A and 4 of oqx B (7.1 (46.4%) were positive for aac (6 ’) - Ib-cr, 10 (17.9%) were positive for qnr A and 3 (5.4%) were positive for qnr B, qnr C, qnr D, qep A. In addition, 3 (5.4%) serrA gene mutations occurred in Ser83 → Leu, 3 genes (5.4%) in gyrB gene mutation Asp87 → Leu, and 2 (3.6%) mutations in parC gene mutation in Ser80 → Ile. Conclusion The quinolone resistance mechanism of urinary isolated Escherichia coli isolated from outpatients is plasmid-mediated, especially aac (6 ’) - Ib-cr resistance gene. Due to plasmid-mediated quinolone resistance gene spread in different strains, should be strengthened monitoring.