碳青霉烯耐药的铜绿假单胞菌的耐药性研究  

Drug resistance investigation of carbapenem-resistant pseudomonas aeruginosa

作　　者：王炜[1] 苏建荣[1] 

机构地区：[1]首都医科大学附属北京友谊医院检验科,北京100050

出　　处：《临床和实验医学杂志》2013年第10期737-739,共3页Journal of Clinical and Experimental Medicine

基　　金：首都医学发展科研基金资助(编号:2009-1031)

摘　　要：目的分析159株临床分离的非重复碳青霉烯耐药铜绿假单胞菌对抗菌药物的耐药性;为临床合理联合应用抗菌药物治疗碳青霉烯耐药铜绿假单胞菌感染提供实验室证据。方法收集2010年5月至2011年5月,首都医科大学附属北京友谊医院临床检验中心细菌室分离的来自不同患者的铜绿假单胞菌159株。测定单药的最低抑菌浓度(MIC),测定联合用药的MIC,计算部分抑菌指数(FIC),判断药物组合的效应。结果 159株临床分离的非重复碳青霉烯耐药铜绿假单胞菌,单药MIC显示铜绿假单胞菌对于美国临床实验室标准化委员会2010推荐和临床常用抗菌药物敏感率低,呈现多重耐药表型。不同药物组合对于碳青霉烯耐药铜绿假单胞菌的作用也有很大差异。全部菌株在亚胺培南单药耐药的情况下,亚胺培南+妥布霉素表现出53.3%的相加作用,美罗培南+妥布霉素的相加作用与此类似,接近50%。结论碳青霉烯耐药的铜绿假单胞菌通常情况下也会对头孢菌素类、β-内酰胺/β-内酰胺酶抑制剂、氨基糖甙类、氟喹诺酮类等产生多重耐药性。对于碳青霉烯耐药的铜绿假单胞菌,三代头孢菌素联合氨基糖甙类体外实验表现出较高比率的协同作用。Objectives To investigate the drug resistance of 159 clinical isolates of carbapenem resistant Pseudomonas aeruginosa. This study can provide laboratory evidence of rational drugs combinations against carbapenem resistant Pseudomonas aeruginosa for clinical use. Methods Total 159 clinical isolates of Pseudomonas aeruginasa were collected from different patients in May 2010 - May 2011, by clinical laboratory center of Beijing Friendship Hospital, Capital Medical University. Imipenem and Meropenem resistant. Mono - antibiotic MICs were determined by broth micro - dilution method, while combined MICs were detected by checkerboard broth micro - dilution method. The FIC was used for drug combinations effects determination. Possible mechanisms of multi -drug resistance were determined through 3D hydrolysis test and PCR, etc. Re- sults Mono - antibiotic MICs of the 159 carbapenem resistant Pseudomonas aeruginosa showed that these isolates were multi - drug resistant and less sensitive to drugs which were recommended by CLS12010 and used in daily clinical treatment, such as carbapenems, cephalosporins, β- lac- tam/β - lactamase inhibitors, fluoroquinolones, amino - glycoside. These medicines presented multi - drug resistance phenotypes, especial for Cefoperazone/sulbactam, piperacillin/tazobactam. The resistance rates were 100%. For cefepime, fluoroquinolones, aminoglycosides, about half of the bacteria showed resistance, while all bacteria demonstrated be sensitive to polymyxin B. Different drug combinations took effect considerably different against carbapenem resistant Pseudomonas aeruginosa. For the combination of tobramycin and ceftazidime, each mono - drug resistant rate of the test strains was 45%, while the proportion of their synergy effect was 30%. Under the condition that all strains are resistant to imipenem, 53.3% of the imipenem combined with tobramycin still showed additive effect. Similarly, additive effect of meropenem combined with tobramycin was nearly 50%. Conclusion Carbapenem - resistant Pseudomo

关 键 词：铜绿假单胞菌 金属酶多重耐药 外排泵抑制剂 外膜孔道蛋白 

分 类 号：R446.5[医药卫生—诊断学]