耐亚胺培南铜绿假单胞菌金属β-内酰胺酶的检测及耐药性分析  

The metallo-beta-lactamase detection and antibiotic resistance analysis of imipenem-resistant Pseudomonas aeruginosa

作　　者：何力志[1] 黄露萍[1] 李志芳[1] 彭爱红[1] 

机构地区：[1]湖南省第二人民医院,湖南长沙410007

出　　处：《检验医学》2013年第5期353-356,共4页Laboratory Medicine

摘　　要：目的对耐亚胺培南铜绿假单胞菌(PA)进行金属β-内酰胺酶(MBL)的检测及药物敏感性分析,为控制院内PA感染提供依据。方法收集临床分离的PA 460株,筛选亚胺培南耐药株;采用组合纸片法对亚胺培南耐药菌株进行MBL表型检测,用聚合酶链反应(PCR)检测MBL基因型别,并对PCR扩增阳性株进行测序;比较分析产与不产MBL的耐亚胺培南PA耐药谱差异,并对MBL不同基因型别菌株的耐药特征进行分析。结果460株PA中共检出28株MBL表型阳性PA,其中IMP-1型阳性19株、VIM-2型阳性2株。随机选取1例IMP-1型和VIM-2型扩增阳性的菌株进行测序,结果与GenBank注册号AY1686359和AF191564相同;产MBL株对美罗培南耐药率为95.2%,显著高于非产MBL株(73.7%,P<0.05)。产MBL菌株对其他抗菌药物的耐药率均高于非产MBL株,但差异无统计学意义(P>0.05);耐亚胺培南PA产MBL的基因型别不同,耐药性也不同。结论本研究分离的产MBL PA以IMP-1型为主,对临床常用的多种抗菌药物具有高度耐药性,应加强对产酶株的检测和监控,防止耐药性的传播和流行;同时,临床应加强病原学检测,尽可能根据药物敏感性结果选择药物,以达到最佳抗菌效果。Objective To analyze the antibiotic susceptibility of metallo-beta-lactamase （MBL） of imipenem- resistant Pseudomonas aeruginosa （PA） , and provide the reference for nosocomial infection prevention. Methods A total of 460 PA were isolated and collected from 2009 to 2011, and the imipenem-resistant isolates were screened. With the combination of disk diffusion method, the MBL phenotype of imipenem-resistant isolates was detected. The MBL genotype was detected by polymerase chain reaction （PCR）. The positive isolates amplified by PCR were sequenced. The antibiotic resistance of MBL-producing isolates of imipenem-resistant PA was compared with that of non MBL- producing isolates. The antibiotic resistance characteristics of the different genotypes of MBL-producing isolates were analyzed. Results In 460 PA, 28 MBL-producing isolates were identified. The 19 isolates were IMP-1 type, and 2 isolates were VIM-2 type by PCR. The 1 isolate of IMP-1 type and 1 isolate of VIM-2 type were selected randomly and sequenced. GenBank accessions were No. AY1686359 and AF191564, respectively. The resistance rate to meropenem of MBL-producing isolates was 95.2% , which was higher than that of non MBL-producing isolates （73.7% , P 〈 0.05 ）. The resistance rates to other antibiotics of MBL-producing isolates were higher than those of non MBL-producing isolates, but the difference was not statistically significant （ P 〉 0.05 ）. The genotypes of MBL-producing isolates in imipenem- resistant PA were different, and the antibiotic resistances were also different. Conclusions The main genotype of MBL- producing isolates in PA is IMP-1 type. These isolates have strong antibiotic resistance to a lot of antibiotics commonly used in clinic. The epidemiology surveillance of the MBL-producing isolates must be strengthened to prevent and control the resistance spread. Simultaneously, clinical antibiotics should be used according to the antibiotic susceptibility tests.

关 键 词：铜绿假单胞菌 金属Β-内酰胺酶 耐药分析 

分 类 号：R378.99[医药卫生—病原生物学]