铜绿假单胞菌耐药表型与基因型相关性研究  

Relationship between phenotypes and genotypes of drug-resistant Pseudomonas aeruginosa

作　　者：张卫英[1] 余道军[1] 吴盛海[1] 柏向群 谢含[1] 

机构地区：[1]杭州市第一人民医院检验科,浙江杭州310006 [2]杭州市西湖风景名胜区西湖街道社区卫生服务中心,浙江杭州310013

出　　处：《中华医院感染学杂志》2012年第6期1114-1117,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划(2008A129);浙江省中医药管理局科技计划项目(2007CB197)

摘　　要：目的分析铜绿假单胞菌(PAE)对不同抗菌药物的耐药性及其耐药基因的流行状况,探讨不同种类抗菌药物的耐药表型与基因型的相关性。方法采用琼脂稀释法测定14种抗菌药物对40株铜绿假单胞菌的MIC,同时采用PCR方法检测16种耐药基因。结果铜绿假单胞菌对氨曲南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率<30.0%;对碳青霉烯类耐药率>50.0%,对氨基糖苷类抗菌药物耐药率约40.0%,对环丙沙星耐药率为95.0%,喹诺酮类抗菌药左氧氟沙星与环丙沙星耐药率相比,差异有统计学意义(P<0.01);40株PAE耐药编码基因Tem、OXA-2、Ant(2′)-Ⅰ、oprD2、IPM、Ant(3″)-Ⅰ、CTX-M-1、Aac(3)-Ⅱ、OXA-10、CTX-M-9、VIM的检出率分别为:15.0%、10.0%、42.5%、7.5%、7.5%、15.0%、2.5%、7.5%、7.5%、7.5%、12.5%,其余耐药基因(SHV、DHA、Aac(6′)-Ⅱ、Aac(6′)-Ⅰ、VIM-2)未检出;亚胺培南/西司他丁耐药株与敏感株的金属酶编码基因IPM的检出率,差异有统计学意义(P<0.01),其余金属酶编码基因的检出率差异无统计学意义。结论铜绿假单胞菌对多种抗菌药物耐药率高,耐药机制复杂多样,对氨基糖苷类抗菌药物的耐药机制,主要与其携带氨基糖苷类修饰酶编码基因有关,对亚胺培南/西司他丁耐药的主要原因是产生金属酶IPM、oprD2缺失与铜绿假单胞菌多药耐药有一定的相关性。OBJECTIVE To investigate the trend of antimicrobial resistance and the prevalence of resistant genes in Pseudomonas aeruginosa and discuss the relativity of phenotypes and genotypes of drug-resistant P.aeruginosa against different types of antibiotics.METHODS MICs of 14 antimicrobials to 40 strains of P.aeruginosa were determined by agar dilution method,at the same time,16 drug-resistance genes were detected by PCR.RESULTS The drug resistance rates to aztreonam,piperacillin/tazobactam,cefoperazone/sulbactum of P.aeruginosa were less than 30.0%;the resistance rates to carbapenem antibiotics were above 50.0%,aminoglycoside 40.0%,ciprofloxacin 95.0%;as compared with the resistance rates to ciprofloxacin and levofloxacin,the difference was statistically significant（P0.01）;the detection rates of drug-resistant encoding genes including Tem,OXA-2,Ant（2″）-Ⅰ,oprD2,IPM,Ant（3″）,CTX-M-1,Aac（3）-Ⅱ,OXA-10,CTX-M-9,VIM were respectively as follows：15.0%,10.0%,42.5%,7.5%,7.5%,15.0%,1.5%,7.5%,7.5%,7.5%,and 12.5%;resistance genes like SHV,DHA,Aac（6′）-Ⅱ,aac（6′）-Ⅰ and VIM-2 were not detected;there was statistical difference in the detection rate of metal enzyme gene IPM between imipenem/cilastatin sodium-resistant and susceptible strains（P0.01）,the difference in the detection rates of other metal enzyme encoding genes were not statistically significant.CONCLUSION The drug resistance rate of P.aeruginosa is high to common antibiotics,with complex drug resistance mechanisms;the mechanisms of aminoglycoside-resistance is closely related to AMEs genes;lack-of oprD2 may lead to the resistance of imipenem/cilastatin,which is also associated with the multidrug-resistance of P.aeruginosa.

关 键 词：铜绿假单胞菌 耐药性 基因型 氨基糖苷类修饰酶 金属酶 

分 类 号：R378.991[医药卫生—病原生物学]