中国部分地区铜绿假单胞菌耐药性及主要β内酰胺酶基因型分布  

Resistance of Pseudomonas aeruginosa and genotyping of the main β-lactamases in China

作　　者：周志慧[1] 吕芳芳[1] 周建英[1] 俞云松[1] 沈萍[1] 魏泽庆[1] 瞿婷婷[1] 

机构地区：[1]浙江大学医学院附属第一医院感染科传染病诊治国家重点实验室,杭州310003

出　　处：《中华传染病杂志》2010年第10期577-581,共5页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金资助项目（30670930）

摘　　要：目的 了解中国各地区铜绿假单胞菌对常用抗菌药物的耐药情况及其主要β内酰胺酶基因型的分布.方法 收集中国16个城市28家医院2006年7月至2007年7月临床分离的铜绿假单胞菌645株.采用Etest法或Kirby-Bauer纸片扩散法测定其对11种常用抗菌药物的敏感性,应用PCR扩增及序列分析确定所有菌株TEM、SHV、CTX-M、OXA等β内酰胺酶的基因型.统计学处理采用SPSS 11.0软件.结果 645株铜绿假单胞菌对11种抗菌药物的耐药率高,仅对阿米卡星及美罗培南的耐药率＜30%.其中对亚胺培南和（或）美罗培南不敏感的菌株为275株,占42.64%,多重耐药铜绿假单胞菌368株,占57.05%,对所检测抗菌药物全部耐药的铜绿假单胞菌菌株为20株,占3.10%.从基因型分布情况来看,阳性率最高的为OXA-10群共51株,其次CARB型37株,TEM型36株,PER型35株,CTX-M型11株,VEB型9株,SHV型5株,金属酶基因型阳性的24株,GES基因型1株,未检测到质粒介导的AmpC酶及其他碳青霉烯酶基因型.并在铜绿假单胞菌中发现了CTX-M-13、CTX-M-14、CTX-M-15、CTX-M-3基因型的超广谱β内酰胺酶基因.结论 中国28家医院临床分离的铜绿假单胞菌耐药情况比较严重.β内酰胺酶基因型以OXA-10及PSE-1为主.在对碳青霉烯类抗菌药物不敏感的或敏感的铜绿假单胞菌中,β内酰胺酶基因型分布也有所不同.Objective To investigate the resistance of Pseudomonas aeruginosa and genotyping of the main β-lactamases in China. Methods A total of 645 Pseudomonas aeruginosa isolates were collected from 28 hospitals in 16 cities in China from July 2006 to July 2007. The susceptibilities to 11 kinds of antimicrobial agents were detected by agar dilution or Kirby-Bauer disk diffusion method. The genotypes of β-lactamases including TEM, SHV, CTX-M and OXA of all the strains were detected by polymerase chain reaction （PCR） and sequence analysis. Results The resistance rates of 645 Pseudomonas aeruginosa isolates to antimicrobial agents were high, except those to amikacin and meropenem were lower than 30 %. Two hundred and seventy-five （42. 64 % ） strains were carbapenem and （or） meropenem-nonsusceptible Pseudomonas aeruginosa. Three hundred and sixty-eight （57.05 %） strains were multidrug-resistant Pseudomonas aeruginosa and 20 （3. 10%） strains were pandrug-resistant. The genotyping results of β-lactamases were as follows： 51 stains produced OXA-10 group β-lactamases, 37 were CARB type, 36 were TEM, 35 were PER, 11 were CTX-M, 9 were VEB, 5 were SHV, 24 were metallo-β-lactamases positive and 1 was GES. None of genotypes of plasmidmediated AmpC enzyme and other carbapenemases were detected. CTX-M-13, CTX-M-14,CTX-M-15, CTX-M-3 of extended spetrum β-lactamese were detected in Pseudomonas aeruginosa.Conclusions The situation of Pseudomonas aeruginosa resistances is severe in China. OXA-10 and PSE-1 are the most common genotypes of β-lactamases. The β-lactamases genotyping is different between carbapenem-nonsusceptible and carbapenem-susceptible strains.

关 键 词：假单胞菌 铜绿 抗药性 多种 细菌 噻烯霉素类 抗菌药 Β内酰胺酶类 基因型 

分 类 号：R686[医药卫生—骨科学]