泛耐药铜绿假单胞菌感染危险因素及产金属β-内酰胺酶调查分析  

Investigation and analysis of risk factors of pandrug-resistant Pseudomonas aeruginosainfection and production of metallo-β-lactamases

作　　者：蔡兴俊[1] 吴华[2] 黄奕江[1] 莫濡冰[1] 

机构地区：[1]海南省人民医院呼吸内科,海南海口570311 [2]海南省人民医院检验科,海南海口570311

出　　处：《中华医院感染学杂志》2014年第3期534-536,共3页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金项目(808203)

摘　　要：目的分析泛耐药铜绿假单胞菌感染各项危险因素,并调查临床分离泛耐药菌株产金属β-内酰胺酶检出率。方法收集2010年1月-2011年6月细菌室从住院患者送检各类标本中分离到的590株铜绿假单胞菌,其中泛耐药铜绿假单胞菌38株,所有菌株的鉴定和药敏试验使用法国生物梅里埃公司的VITEK-2全自动微生物分析仪,对泛耐药铜绿假单胞菌采用K-B法进行确证,采用亚胺培南-EDTA双纸片协同法进行泛耐药菌株金属β-内酰胺酶确证试验。结果 38株泛耐药铜绿假单胞菌主要分离自痰标本,占86.8%;主要分布在重症医学科和呼吸内科,各占36.8%;年龄、住院天数、营养不良、机械通气、人工气道、脑梗死、结构性肺病、广谱抗菌药物的应用等因素与泛耐药铜绿假单胞菌感染相关(P<0.05);性别、糖尿病与泛耐药铜绿假单胞菌感染无明显相关性;依据双纸片协同法检测金属β-内酰胺酶,产酶率为52.6%。结论泛耐药铜绿假单胞菌感染危险因素为年龄、住院天数、营养不良、机械通气、人工气道、脑梗死、结构性肺病、广谱抗菌药物的应用,临床应注意防范;泛耐药菌株产酶率较高,为重要的耐药机制。OBJECTIVE To analyze the risk factors of pandrug-resistant Pseudomonas aeruginosa infection, and investigate the detection rate of production of metallo-β-lactamases （MBLs） in clinical isolated pandrug-resistant strains. METHODS A total of 590 strains of P. aeruginosa isolated from the specimens of the inpatients in the bacteriology room were collected from Jan. 2010 to Jun. 2011, of which 38 strains were pandrug-resistant. The identification and drug susceptibility tests of all the strains were performed using VITEK 2 full-automatic microbial analyzer manufactured by Biomerieux Co. LTD（France）, and the pandrug-resistant P. aeruginosa were identified by the K-B method. Imipenem-EDTA combined double disc synergy test was used to confirm the production of metallo-β-lactamases of pandrug-resistant P. aeruginosa. RESULTS Totally 38 strains of pandrug-resistant P. aeruginosa were mainly isolated from sputum specimens, accounting for 86.8%; the cases mainly distributed in intensive care unit （36. 8 %） and respiratory medicine （ 36. 8 %） ; pandrug-resistant P. aeruginosa infection was related with age, the time of hospitalization, malnutrition, mechanical ventilation, artificial airway, cerebral infarction, structural lung diseases, and the application of broad-spectrum antibiotics（P〈0.05）; no significant correl.ation with genders and diabetes. Production rate of metallo-β-lactamase was 52.60% according to the double disc synergy test. CONCLUSION The risk factors of pandrug-resistant P. aeruginosa infection are age, the time of hospitalization, malnutrition, mechanical ventilation, artificial airway, cerebral infarction, structural lung disease, and application of broad-spectrum antibiotics, which should be clinical prevented. Higher enzyme production rate of pandrug-resistant strains is an important mechanism of resistance.

关 键 词：铜绿假单胞菌 泛耐药 危险因素 金属Β-内酰胺酶 

分 类 号：R378.991[医药卫生—病原生物学]