对碳青霉烯类抗生素耐药铜绿假单胞菌耐药机制及耐药性的研究  被引量:6

Analysis of the mechanism and antibiotic resistance of carbapenem-resistant Pseudomonas aeruginosa

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作  者:董方[1] 徐樨巍[1] 宋文琪[1] 吕萍[1] 杨永弘[1] 沈叙庄[1] 

机构地区:[1]首都医科大学附属北京儿童医院细菌室,100045

出  处:《中国感染与化疗杂志》2008年第5期334-337,共4页Chinese Journal of Infection and Chemotherapy

基  金:国家科技部十五攻关项目(2004BA720A09-01)

摘  要:目的了解目前儿科临床分离对碳青霉烯类抗生素耐药铜绿假单胞菌外膜孔蛋白OprD2缺失和金属β内酰胺酶(MBL)产生的情况,及具有不同耐药机制菌株的耐药特点。方法收集2004年1月—2006年12月从我院住院患儿中分离出的75株对碳青霉烯类抗生素耐药铜绿假单胞菌。用PCR方法进行oprD2基因、金属酶IMP、VIM、SPMT和GIM基因检测。用琼脂稀释法进行药敏试验,按照2006年CLSI推荐标准判断结果。使用WHONET5.3和SPSS13.0软件进行数据分析。结果检测75株对碳青霉烯类抗生素耐药的铜绿假单胞菌中外膜孔蛋白OprD2缺失者50株,占66.7%;产金属酶的46株,占61.3%,其中IMP阳性38株(82.6%),VIM阳性8株(17.4%)。外膜孔蛋白OprD2缺失同时产金属酶的34株,占45.3%,其对β内酰胺类抗生素的耐药率、MIC50和MIC90均高于其他菌株。结论目前从儿科临床分离对碳青霉烯类抗生素耐药铜绿假单胞菌外膜孔蛋白OprD2缺失和产生金属酶都十分严重,菌株的耐药性也很高,并且产MBL菌株存在IMP和VIM2种基因型。Objective To investigate the loss of OprD2 porin and metallo-β-1actamases (MBL) produced by carbapenem-resistant Pseudomonas aeruginosa, and analyze antibiotic resistance of carbapenem-resistant P. aeruginosa in pediatric patients. Methods Seventy-five strains of carbapenem-resistant P. aeruginosa isolated from January 2004 to December 2006 in our hospital were analyzed. Genes encoding outer membrane proteins oprD2 porin and MBLs were amplified by PCR. Minimum inhibitory concentrations of antimicrobial agents against these strains were determined. Results were analyzed according to the guidelines of Clinical and I,aboratory Standard Institute (CLSI). WHONET 5.3 and SPSS13.0 software were used to analyze the data. Re- sults Loss of OprD2 porin was identified in 50 (66.7%) of the 75 carbapenem-resistant P. aeruginosa strains and MBLs were identified in 46 (61.3%) of the 75 strains. Among the MBL-positive isolates, 38 (82.6%) carried blaIMP gene, 8 (17.4%) with blaVIM gene. Loss of OprD2 porin was found in 34 (45.3%) MBL-positive isolates. These 34 strains were more resistant to ^-lactam antibiotics than other isolates. Conclusions Loss of OprD2 porin and MBLs-production is prevalent in the carbapenem-resistant P. aeruginosa isolated from pediatric patients. The isolate producing MBLs but missing OprD2 porin is highly resistant. Two genotypes, IMP and VIM, are identified in MBL-producing strains.

关 键 词:铜绿假单胞菌 外膜孔蛋白OprD2 金属Β内酰胺酶 耐药性 儿童 

分 类 号:R446.5[医药卫生—诊断学]

 

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