儿科临床分离铜绿假单胞菌对β-内酰胺类耐药相关基因的研究  

Analysis of resistant genes of beta-lactam antibiotics from Pseudomonas aeruginosa in pediatric patients

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：《中华医学杂志》2008年第42期3012-3015,共4页National Medical Journal of China

基　　金：国家科技部“十五”攻关项目基金资助（2004BA720A09-01）

摘　　要：目的研究儿科临床分离对β-内酰胺类抗生素耐药铜绿假单胞菌的耐药性及其对β-内酰胺类耐药相关基因的检出情况。方法收集2004年1月至2006年12月北京儿童医院住院患儿中分离出的146株对β-内酰胺类抗生素耐药铜绿假单胞菌。使用琼脂稀释法进行药敏试验，测定抗菌药物的最低抑菌浓度（MIC）值，按照临床实验室标准化研究所（CLSI）推荐标准判断结果，再使用PCR方法进行β-内酰胺类耐药相关基因的检测。采用WHONET5．3软件进行数据分析。结果146株对β-内酰胺类抗生素耐药铜绿假单胞菌多呈现多重耐药现象。产金属β-内酰胺酶的共46株（31．5％），IMP基因阳性38株（82．6％），VIM基因阳性8株（17．4％）。外膜孔蛋白OprD2缺失的114株，占78．1％。对超广谱β-内酰胺酶TEM、SHV、OXA、PER、GES、CTX-M和质粒型AmpC酶DHA、MIR及FOX基因的检测均为阴性。结论目前儿科临床分离对β-内酰胺类抗生素耐药铜绿假单胞菌，产生金属酶及外膜孔蛋白OprD2缺失是其耐药的主要原因，并且外膜孔蛋白OprD2缺失现象更为严重。Objective To analyze the antibiotic resistance of the Pseudomonas aeruginosa （PA） isolated from pediatric patients and the resistant genes of beta-lactam antibiotics thereof. Methods 146 PA strains were isolated from podiatric patients. Agar dilution method recommended by the Clinical and Laboratory Standards Institute was used to examine the minimum inhibitory concentrations （MICs） of 12 antimicrobial agents, including the penicillins, third and fourth genet ration cephalosporins, carbapenemases, Aztreonam, β-1actamase inhibitors, quinolones, and aminoglycosides. PCR was used to detect the expression of the genes TEM, SHV, OXA, PER, GES, CTX-M,IMP, VIM,DHA, MIR, FOX, and oprD2. Results The multi-drug resistance rates against different antibiotic were high among the 146 PA strains. The rates of imiponem and meropenem resistance were 41.1% and 35.6% respectively. Among the 146 PA strains, 46 （31.5%） were positive for the MBL genotype; 38 （82.6%） carried the blalMP gene, 8 （17.4%） carried the blaVIM gene, and 114 （78.1%） were oprD2 negative. The genes TEM, SHV, OXA, CTX-M, PER, VEB, GES, FOX, MIR, and DHA were not found in all strains. Conclusion Many PA isolated from podiatric patients carry the genes IMP or VIM and losses oprD2 gene related to the expression of the outer membrane porin OprD2. The loss of the gene oprD2 is essential mechanism of beta- lactam antibiotics resistance in PA.

关 键 词：假单胞菌 铜绿 Β内酰胺酶类 儿童 耐药性 

分 类 号：R686[医药卫生—骨科学]