摘要目的 对医院污水中分离到的病原菌进行耐药性分析及耐药基因检测,探讨环境中具有抗生素耐药性的微生物来源.方法 收集2016年1—12月从绍兴地区3家医院污水中分离到的耐热大肠菌群、沙门菌和志贺菌等肠道致病菌,检测耐热大肠菌群的耐药性,并与3家医院临床标本中分离到的大肠埃希菌耐药性进行对比分析,同时检测污水中耐热大肠埃希菌的超广谱β-内酰胺酶(ESBLs)耐药基因.结果 污水中共分离到48株病原菌,包括32株大肠埃希菌、2株宋内志贺菌和1株亚利桑那沙门菌.大肠埃希菌对绝大多数抗生素具有较低的耐药率,与临床标本中分离到的大肠埃希菌相比,氨苄西林、氨曲南、阿莫西林/棒酸和头孢菌素的耐药率差异具有统计学意义(P<0.05).污水中共检测到11株ESBLs阳性菌株,其中有7株携带CTX-M9耐药基因,4株携带TEM耐药基因,携带CTX-M1和SHV各1株,有2株同时携带CTX-M9和TEM耐药基因,1株同时携带TEM和SHV耐药基因.结论 医院污水中存在着不同种类的肠道致病菌,可能导致环境中耐药微生物的污染,医院应加强污水处理质量,提高污水消毒合格率.

abstractsObjective To analyze the drug resistance and detect the drug resistance genes of pathogenic bacteria isolated from hospital sewage , and to investigate the sources of antibiotic resistant microorganisms in the environment .Methods The enteric pathogenic bacteria , such as thermotolerant Escherichia coli , Salmonella and Shigella , were isolated from the sewage of Shaoxing hospitals from January 2016 to December 2016 , and the detection of drug resistance of thermotolerant Escherichia coli , the drug resistance of Escherichia coli isolated from clinical specimens of three hospitals was compared and analyzed . Meanwhile , extended spectrum beta lactamases ( ESBLs ) resistance genes were detected in thermotolerant Escherichiacoliinsewage.Results 48strainsofpathogenswereisolatedinsewage,including32strainsof Escherichia coli , 2 strains of Shigella sonnei and 1 strain of Salmonella arizonae .Escherichia coli has a low rate of resistance to most antibiotics .Compared to Escherichia coli isolated from clinical specimens , there were significant differences among the drug resistance rates of Ampicillin , Aztreonam, Amoxicillin/Clavulanic acid and the first to four generation Cephalosporins (P<0.05).11 strains of ESBLs positive bacteria were detected in sewage .Among them , 7 carried CTX-M9 resistance genes , and 4 carried TEM resistance genes , while 1 strain of CTX-M1 and SHV was carried .There were 2 strains carrying CTX-M9 and TEM resistance genes simultaneously , 1 strain simultaneously carrying TEM and SHV resistance genes . Conclusions There are different kinds of intestinal pathogens in hospital sewage , which may lead to contamination of drug-resistant microorganisms in the environment .Therefore the hospitals should strengthen the quality of sewage treatment and improve the qualified rate of sewage disinfection .