铜绿假单胞菌产AmpC β-内酰胺酶及外膜孔蛋白OprD_2基因缺失分析  

Analysis of AmpC beta-lactamase and outer membrane porin OprD_2 gene deletion in Pseudomonas aeruginosa

作　　者：徐伟红 徐斌 姚怡婷 黄明敏 张骏[2] 赵虎[3] 

机构地区：[1]上海同仁医院,上海200050 [2]复旦大学附属华山医院,上海200041 [3]复旦大学附属华东医院,上海200040

出　　处：《检验医学》2016年第4期309-313,共5页Laboratory Medicine

基　　金：上海市长宁区科委资助项目(CNKW2014Z04)

摘　　要：目的了解临床分离的铜绿假单胞菌中产Amp Cβ-内酰胺酶(简称Amp C酶)及外膜孔蛋白Opr D_2基因缺失的情况。方法采用三维试验检测Amp C酶,聚合酶链反应(PCR)检测外膜孔蛋白Opr D_2基因和Amp C酶结构基因amp C,进行统计学分析。结果 63株铜绿假单胞菌中Amp C酶阳性14株(22.22%);Opr D_2基因阳性22株(Opr D_2基因缺失率65.08%);amp C基因阳性62株(93.94%)。铜绿假单胞菌对氨苄西林、氨苄西林-舒巴坦、头孢替坦、头孢曲松和头孢唑啉的耐药率达100.00%。产Amp C酶的菌株对亚胺培南、庆大霉素、头孢吡肟的耐药率分别为42.85%、64.29%和57.14%,不产Amp C酶的菌株分别为30.61%、6.12%和14.29%,二者对庆大霉素和头孢吡肟的耐药率差异均有统计学意义(P<0.01),对亚胺培南的耐药率差异无统计学意义(P>0.05)。6株Opr D_2缺失合并产Amp C酶的铜绿假单胞菌对亚胺培南、头孢他啶、头孢吡肟的耐药率分别为100.00%、66.67%和55.56%,8株Opr D_2正常表达合并产Amp C酶的菌株分别为0.00%、25.00%和37.50%,二者差异有统计学意义(P<0.05)。结论铜绿假单胞菌多重耐药可能是由多种机制共同控制的,应加强铜绿假单胞菌产酶的监测及耐药基因的分子流行病学研究。Objective To understand Amp C beta-lactamase（Amp C） and outer membrane porin Opr D_2 gene deletion in Pseudomonas aeruginosa. Methods The three-dimensional test was used to determine Amp C. Polymerase chain reaction（PCR） was used to determine outer membrane porin Opr D_2 gene and amp C gene. The data were analyzed statistically. Results The 63 isolates of Pseudomonas aeruginosa were collected,of which 14 isolates（22.22%） produced Amp C,Opr D_2 gene was positive in 22 isolates（Opr D_2 gene deletion rate 65.08%）,and amp C gene was positive in 62 isolates（93.94%）. The resistance rates to ampicillin,ampicillin / sulbactam,cefotetan and ceftriaxone and cefazolin were 100.00%. The resistance rates of Amp C-producing isolates to imipenem,gentamicin and cefepime were 42.85%,64.29% and 57.14%,respectively. The resistance rates of non-Amp Cproducing isolates were 30.61%,6.12% and 14.29%,respectively. The resistance rates of Pseudomonas aeruginosato gentamicin and cefepime had statistical significance between Amp C- p roducing and non-Amp C-producing isolates（P〈0.01）,but there was no statistical significance for imipenem（P〈0.05）. A total of 6 isolates of Pseudomonas aeruginosa had Opr D_2 gene deletion,and the resistance rates to imipenem,ceftazidime and cefepime were 100.00%,66.67% and 55.56%. The resistance rates of 8 isolates of Pseudomonas aeruginosa with normal Opr D_2 gene expression and Amp C-producing isolates were 0.00%,25.00% and 37.50%. Conclusions Multi-drug resistant Pseudomonas aeruginosa might be caused by a variety of mechanisms. Enzyme production and molecular epidemiological studies for Pseudomonas aeruginosa should be strengthened.

关 键 词：铜绿假单胞菌 AMPC Β-内酰胺酶 OprD2基因 AMPC基因 

分 类 号：R446.5[医药卫生—诊断学]