血液病患者肛周定植产超广谱β-内酰胺酶大肠埃希菌耐药表型和分子流行特征

doi:10.3969/j.issn.1673-8640.2026.01.016

摘要/Abstract

摘要：

目的分析血液病患者肛周定植产超广谱β-内酰胺酶大肠埃希菌（ESBL-Ec）的耐药表型和分子流行特征，为临床抗感染治疗提供参考。方法收集2023年7月9日—2024年7月9日上海交通大学医学院附属瑞金医院血液科250株ESBL-Ec非重复临床分离株，从中随机抽取100株进行纸片扩散法体外药物敏感性试验和耐药基因检测，以及多位点序列分型（MLST）。结果 100株ESBL-Ec临床分离株对氨苄西林、头孢唑林、头孢呋辛均100%耐药，对头孢曲松的耐药率为99%，对左氧氟沙星、四环素、复方磺胺甲噁唑的耐药率为66%~82%，对庆大霉素、头孢吡肟、头孢他啶、氨苄西林-舒巴坦、氨曲南、妥布霉素、头孢西丁、哌拉西林-他唑巴坦的耐药率为16%~45%，对阿米卡星、磷霉素、厄他培南、呋喃妥因、亚胺培南、美罗培南、头孢他啶-阿维巴坦的耐药率<10%。检出率居前3位的耐药基因依次为blaCTX-M-14（45%）、blaTEM-1（44%）、blaCTX-M-55（33%）；居前3位的ST型别依次为ST648（14%）、ST38（13%）、ST10（6%），流行程度居前3位的CC群依次为CC648（14%）、CC38（13%）、CC131（10%）。结论上海交通大学医学院附属瑞金医院血液科患者肛周定植的ESBL-Ec仅对碳青霉烯类抗菌药物具有较高的敏感性。耐药基因blaTEM检出率已居第2位，ST648型别有较高的流行趋势，临床加强监控，防止质粒传播导致的耐药。

关键词: 大肠埃希菌, 产超广谱β-内酰胺酶, 碳青霉烯酶, 耐药基因, 定植, 血液病, 血流感染

中图分类号:

R378.2

朱德栋, 肖淑珍, 谢潋滟, 周思琪, 王鲁灵, 韩立中. 血液病患者肛周定植产超广谱β-内酰胺酶大肠埃希菌耐药表型和分子流行特征[J]. 检验医学, 2026, 41(1): 89-94.

图/表 3

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目标基因	引物名	引物序列（5'~3'）	产物长度/bp
adk	adk-F	TCATCATCTGCACTTTCCGC	583
	adk-R	CCAGATCAGCGCGAACTTCA
Fumc	Fumc-F	TCACAGGTCGCCAGCGCTTC	806
	Fumc-R	GTACGCAGCGAAAAAGATTC
Gyrb	Gyrb-F	TCGGCGACACGGATGACGGC	911
	Gyrb-R	ATCAGGCCTTCACGCGCATC
Icd	Icd-F	ATGGAAAGTAAAGTAGTTGTTCCGGCACA	878
	Icd-R	GGACGCAGCAGGATCTGTT
Mdh	Mdh-F	ATGAAAGTCGCAGTCCTCGGCGCTGCTGGCGG	932
	Mdh-R	TTAACGAACTCCTGCCCCAGAGCGATATCTTTCTT
PurA	PurA-F	TCGGTAACGGTGTTGTGCTG	816
	PurA-R	CATACGGTAAGCCACGCAGA
RecA	RecA-F	CGCATTCGCTTTACCCTGACC	780
	RecA-R	TCGTCGAAATCTACGGACCGGA
TEM	TEM-F	ATAAAATTCTTGAAGACGAAA	1080
	TEM-R	GACAGTTACCAATGCTTAATC
SHV	SHV-F	TGGTTATGCGTTATATTCGCC	865
	SHV-R	GGTTAGCGTTGCCAGTGCT
CTX-M-1	CTX1-F	AAAAATCACTGCGCCAGTTC	415
	CTX1-R	AGCTTATTCATCGCCACGTT
CTX-M-9	CTX9-F	CAAAGAGAGTGCAACGGATG	205
	CTX9-F	ATTGGAAAGCGTTCATCACC

目标基因	引物名	引物序列（5'~3'）	产物长度/bp
adk	adk-F	TCATCATCTGCACTTTCCGC	583
	adk-R	CCAGATCAGCGCGAACTTCA
Fumc	Fumc-F	TCACAGGTCGCCAGCGCTTC	806
	Fumc-R	GTACGCAGCGAAAAAGATTC
Gyrb	Gyrb-F	TCGGCGACACGGATGACGGC	911
	Gyrb-R	ATCAGGCCTTCACGCGCATC
Icd	Icd-F	ATGGAAAGTAAAGTAGTTGTTCCGGCACA	878
	Icd-R	GGACGCAGCAGGATCTGTT
Mdh	Mdh-F	ATGAAAGTCGCAGTCCTCGGCGCTGCTGGCGG	932
	Mdh-R	TTAACGAACTCCTGCCCCAGAGCGATATCTTTCTT
PurA	PurA-F	TCGGTAACGGTGTTGTGCTG	816
	PurA-R	CATACGGTAAGCCACGCAGA
RecA	RecA-F	CGCATTCGCTTTACCCTGACC	780
	RecA-R	TCGTCGAAATCTACGGACCGGA
TEM	TEM-F	ATAAAATTCTTGAAGACGAAA	1080
	TEM-R	GACAGTTACCAATGCTTAATC
SHV	SHV-F	TGGTTATGCGTTATATTCGCC	865
	SHV-R	GGTTAGCGTTGCCAGTGCT
CTX-M-1	CTX1-F	AAAAATCACTGCGCCAGTTC	415
	CTX1-R	AGCTTATTCATCGCCACGTT
CTX-M-9	CTX9-F	CAAAGAGAGTGCAACGGATG	205
	CTX9-F	ATTGGAAAGCGTTCATCACC