急性重症胆囊炎介入治疗后胆囊感染大肠埃希菌基因型及毒力因子

Genotypes and virulence factors of Escherichia coli of gallbladder infection in patients with acute severe cholecystitis after interventional treatment

    摘要
  • 摘要: 目的 分析急性重症胆囊炎介入治疗后胆囊感染大肠埃希菌的基因型及毒力因子。方法 收集2019年10月-2021年8月青岛市中医医院急性重症胆囊炎介入治疗后胆囊感染患者分离的60株大肠埃希菌样本，采用VITEK-2细菌自动鉴定及药敏检测卡进行菌株鉴定和药敏试验，多重聚合酶链反应(PCR)检测菌株毒力因子基因(黏附素类毒力因子：papGalleleⅡ(Internal)、PapEF、papC，铁载体蛋白类毒力因子：fyuA、iutA，致病岛类毒力因子：PAI，毒素类毒力因子：cvaC、cnf1(CNF)，保护素类毒力因子：kpsMⅡ、K5，采用Logistic回归分析探究毒力因子与抗菌药物耐药性之间的关系。结果 大肠埃希菌对美罗培南和头孢吡肟敏感率均为100.00%，对氨苄西林、磺胺甲噁唑/甲氧苄啶、哌拉西林、左氧氟沙星、头孢呋辛和庆大霉素的耐药率分别为86.67%、85.00%、78.33%、66.67%、56.67%和53.33%；耐≥3种抗菌药物的多药耐药率达51.67%(31/60)；10种毒力因子基因均能检出，其中papGalleleⅡ(Internal)、PapEF、papC、fyuA、iutA、PAI、cvaC、cnf1、kpsMⅡ、K5检测率分别为100.00%、46.67%、61.66%、48.33%、100.00%、63.33%、46.67%、100.00%、100.00%和48.33%；Logistic回归分析显示，大肠埃希菌对左氧氟沙星的耐药性与毒力因子iutA有关，对磺胺甲噁唑/甲氧苄啶的耐药性与papGalleleⅡ(Internal)有关(P<0.05)。结论 急性重症胆囊炎介入治疗后胆囊感染患者分离的大肠埃希菌对氨苄西林、磺胺甲噁唑/甲氧苄啶、哌拉西林、左氧氟沙星、头孢呋辛和庆大霉素不同程度耐药，对美罗培南和头孢吡肟高度敏感，均携带papGalleleⅡ、iutA、cnf1、kpsMⅡ毒力基因，其耐药机制可能与相关毒力基因表达有关。

     

    Abstract: OBJECTIVE To analyze the genotypes and virulence factors of Escherichia coli in the gallbladder infection of patients with acute severe cholecystitis after interventional treatment. METHODS Totally 60 samples of E .coli strains isolated from patients with gallbladder infection after interventional therapy for acute severe cholecystitis in Qingdao Hospital of Traditional Chinese Medicine between Oct. 2019 and Aug. 2021 were collected. VITEK-2 automatic bacterial identification and drug sensitivity test card were used for strain identification and drug sensitivity test, and multiple polymerase chain reaction (PCR) was used to detect the virulence factors genes of strains (adhesin-like virulence factors of papGallele II (Internal), Pap EFand papC, siderophore protein-like virulence factors of fyuA and iutA, pathogenic island-like virulence factor of PAI, toxin-like virulence factors of cvaC and cnf1 (CNF), and protectin-like virulence factors of kpsM II and K5), and Logistic regression analysis was used to explore the relationship between virulence factors and antimicrobial resistance. RESULTS The sensitivity rates of E. coli to both Meropenem and Cefepime were 100.00%, and the resistance rates to ampicillin, sulfamethoxazole/trimethoprim, piperacillin, levofloxacin, cefuroxime and gentamicin were 86.67%, 85.00%, 78.33%, 66.67%, 56.67% and 53.33%, respectively. The multidrug resistance rate of≥3 kinds of antibacterial drugs reached 51.67% (31/60). All 10 virulence factor genes were detected, and the detection rates of papGallele II (Internal), PapEF, papC, fyuA, iutA, PAI, cvaC, cnf1, kpsM II and K5 were 100.00%, 46.67%, 61.67%, 48.33%, 100.00%, 63.33%, 46.67%, 100.00%, 100.00% and 48.33%, respectively. Logistic regression analysis showed that the drug resistance of Escherichia coli to levofloxacin was associated with virulence factor iutA, and the drug resistance to sulfamthoxazole/trimethoprim was associated with papGallele II (Internal) (P<0.05). CONCLUSION Escherichia coli strains isolated from patients with gallbladder infection after interventional therapy for acute severe cholecystitis were resistant to ampicillin, sulfamthoxazole/trimethoprim, piperacillin, levofloxacin, cefuroxime and gentamicin to varying degrees and highly susceptible to Meropenem and Cefepime, all of which carried virulence genes of papGallele II, iutA, cnf1 and kpsM II, and the resistance mechanism might be related to the expressions of relevant virulence genes.

     

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