大型质粒介导泛耐药铜绿假单胞菌耐药机制及防治对策  

Pan-resistant Pseudomonas aeruginosa′sresistance mechanism mediated by large plasmid and countermeasures of prevention and treatment

作　　者：吴俊[1] 赵子文[2] 陈惠玲[3] 熊剑辉[3] 

机构地区：[1]马鞍山市人民医院呼吸科,安徽马鞍山243000 [2]广州市第一人民医院呼吸科,广东广州510180 [3]广州市第一人民医院检验科,广东广州510180

出　　处：《中华医院感染学杂志》2013年第7期1487-1489,1493,共4页Chinese Journal of Nosocomiology

基　　金：广东省自然科学基金(A5000423)

摘　　要：目的探讨泛耐药铜绿假单胞菌流行及耐药机制和有效的防治措施,以降低耐药率。方法收集2002-2005年广州一所三甲医院呼吸重症监护病房泛耐药、多药耐药、普通感染的铜绿假单胞菌,对上述铜绿假单胞菌进行分析,包括E-test法进行体外药敏试验,E-test法检测耐药表型、质粒提取、随机引物扩增DNA分型分析同源性,结合临床资料进行耐药谱、基因谱对比研究,统计学采用Fisher确切概率检验。结果共收集27株铜绿假单胞菌,其中泛耐药铜绿假单胞菌7株,E-test试纸法检测其中6株金属β-内酰胺酶阳性,其余菌株均为阴性,曾基因扩增测序确定7株泛耐药铜绿假单胞菌产金属β-内酰胺酶基因,其他多药耐药、普通感染铜绿假单胞菌未检测到该基因,差异有统计学意义(P<0.01);确定为大型质粒介导,且感染患者死亡率高,为71.0%,以质粒为模板同源性分析系同一克隆株。结论产金属β-内酰胺酶是泛耐药铜绿假单胞菌耐药的重要原因,且由大型质粒介导,感染患者均有慢性基础疾病,防治上应采取综合管理。OBJECTIVE To investigate the prevalence and the resistance mechanism of pan-resistant Pseudomonas aeruginosa （PRPA） and explore effective prevention measures. METHODS From 2002 to 2005, the pan-resistant P. aeruginosa strains were collected in the respiration intensive care unit of a tertiary hospital in Guangzhou, including the multidrug-resistant P. aeruginosa （MDRP） and ordinary infected P. aeruginosa. The isolates were analyzed in the following methods： the susceptibility test by the E-Test method, the detection of drug resistance phenotypes with E-Test method and the plasmids extraction, and homology analysis with the random amplified polymorphic DNA sequencing. A comparative study of drug resistance spectrum and the gene spectrum was conducted by combining the clinical data, and the statistical analysis was performed with the Fisher exact probability test. RESULTS Of totally 27 strains of such isolates collected, there were 7 strains of PRPA, the E- Test indicated that there were 6 strains with metallo-O-laetamase tested positive, the rest of the strains tested negative, the gene amplification sequencing determined 7 strains with metallo-β-1actamase tested positive, and the rest of the multidrug-resistant P. aeruginosa and ordinary infected P. aeruginosa strains were not detected with such gene, the difference was statistically significant （P〈0. 001）. The metallo-β-lactamase gene was associated with large plasmid, and the mortality was high （71. 0%）. The plasmid as tempiate with homology analysis showed that they were the same one clone. CONCLUSION The production of metallo-β-1actamase is a leading factor of drug resistance of the pan-resistant Pseudomonas aeruginosa and is mediated by large plasmids. The patients with infections are all complicated with chronic underlying diseases, thus it is necessary to take comprehensive prevention countermeasures.

关 键 词：泛耐药铜绿假单胞菌 金属Β内酰胺酶 质粒 

分 类 号：R378.991[医药卫生—病原生物学]