背景:大肠杆菌(E.大肠杆菌)是一种多药耐药的机会性病原体,可导致COVID-19患者继发细菌感染。本研究旨在确定COVID-19患者继发细菌感染大肠杆菌的耐药性,并评估与外排泵和孔蛋白相关基因的患病率和特征。
方法:共收集50株非重复大肠杆菌分离株作为COVID-19患者的继发细菌感染。从痰样品中培养分离物。Vitek2进行了确认和抗生素药敏试验。PCR用于评估分离物中外排泵和孔蛋白相关基因的患病率。评估了与外排泵相关的抗生素抗性基因的表型和基因型演变。
结果:大肠杆菌分离株表现出对氨苄青霉素的高耐药性(100%),头孢克肟(62%),头孢吡肟(62%),阿莫西林-克拉维酸(60%),头孢呋辛(60%),和头孢曲松(58%)。大肠杆菌对厄他培南的敏感性最大(92%),其次是亚胺培南(88%),美罗培南(86%),替加环素(80%),和左氧氟沙星(76%)。关于外排泵基因组合,acrA基因与左氧氟沙星耐药性增加之间存在显著关联,acrB基因与对美罗培南的抗性降低和对左氧氟沙星的抗性增加之间,以及ompF和ompC基因之间对庆大霉素的抗性增加。
结论:抗生素厄他培南,亚胺培南,美罗培南,替加环素,左氧氟沙星对COVID-19患者的大肠杆菌有效。编码外排泵和孔蛋白的基因,比如acrA,acrB,和外膜孔,在所有分离物中高度分布。外排泵抑制剂可以作为恢复大肠杆菌分离物中四环素活性的替代抗生素。
BACKGROUND: Escherichia coli (E. coli) is a multidrug resistant opportunistic pathogen that can cause secondary bacterial infections in patients with COVID-19. This study aimed to determine the antimicrobial resistance profile of E. coli as a secondary bacterial infection in patients with COVID-19 and to assess the prevalence and characterization of genes related to efflux pumps and porin.
METHODS: A total of 50 nonduplicate E. coli isolates were collected as secondary bacterial infections in COVID-19 patients. The isolates were cultured from sputum samples. Confirmation and antibiotic susceptibility testing were conducted by Vitek 2. PCR was used to assess the prevalence of the efflux pump and porin-related genes in the isolates. The phenotypic and genotypic evolution of antibiotic resistance genes related to the efflux pump was evaluated.
RESULTS: The E. coli isolates demonstrated high resistance to ampicillin (100%), cefixime (62%), cefepime (62%), amoxicillin-clavulanic acid (60%), cefuroxime (60%), and ceftriaxone (58%). The susceptibility of E. coli to ertapenem was greatest (92%), followed by imipenem (88%), meropenem (86%), tigecycline (80%), and levofloxacin (76%). Regarding efflux pump gene combinations, there was a significant association between the acrA gene and increased resistance to levofloxacin, between the acrB gene and decreased resistance to meropenem and increased resistance to levofloxacin, and between the ompF and ompC genes and increased resistance to gentamicin.
CONCLUSIONS: The antibiotics ertapenem, imipenem, meropenem, tigecycline, and levofloxacin were effective against E. coli in patients with COVID-19. Genes encoding efflux pumps and porins, such as acrA, acrB, and outer membrane porins, were highly distributed among all the isolates. Efflux pump inhibitors could be alternative antibiotics for restoring tetracycline activity in E. coli isolates.