ICU铜绿假单胞菌耐药性和消毒剂-磺胺耐药基因的检测及分析  

Drug resistance analysis and detection of disinfectant-sulfadiazine-resistant gene of Pseudomonas aeruginosa isolated from patients in ICU

作　　者：张福华 万言珍 陈佳红 代玉龙 孙雪荣 ZHANG Fu-hua WAN Yan-zhen CHEN Jia-hong DAI Yu-long SUN Xue-rong(Yantai City Hospital for Infectious Diseases, Yantai, Shandong 264000, Chin)

机构地区：[1]烟台市传染病医院检验科,山东烟台264000 [2]青岛市妇女儿童医院检验科,山东青岛266034

出　　处：《中华医院感染学杂志》2017年第7期1445-1447,1473,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解医院ICU铜绿假单胞菌临床分离菌株的耐药特征,检测分析铜绿假单胞菌消毒剂-磺胺耐药基因的携带情况,为指导临床合理应用抗菌药物和合理调整消毒剂的使用提供参考依据。方法选取医院2015年6月-2016年6月ICU病房送检的住院患者包括血、尿、痰、胸腹水及分泌物等各类标本,共获得不重复患者的菌株105株,采用VITEK-2全自动微生物分析仪进行菌株鉴定及药敏试验。结果 105株铜绿假单胞菌对头孢替坦、头孢唑林、磺胺甲噁唑/甲氧苄啶、氨苄西林、氨苄西林/舒巴坦、呋喃妥因耐药率高,均>95.0%;105株铜绿假单胞菌检测qac E△1-sul1基因阳性43株,阳性率40.95%。结论 ICU铜绿假单胞菌的耐药情况已非常严重,应加强对铜绿假单胞菌的耐药性监测,根据药敏结果合理使用抗菌药物,减少耐药株的产生;分离的铜绿假单胞菌qac E△1-sul1基因携带率较高,医院常用消毒剂对铜绿假单胞菌的灭菌效果良好,重症监护室应进一步加强耐消毒剂基因菌株的监控,并根据耐消毒剂情况合理调整消毒剂的使用,尽量避免应用季铵盐类和双胍类消毒剂,严格执行消毒隔离措施,控制医院感染的发生。OBJECTIVE To investigate the condition of drug resistance of Pseudomonas aeruginosa strains isolated from samples of patients in intensive care unit （ICU）, and to detect the distribution of the disinfectant-sulfadia- zinc-resistant gene, so as to provide references for clinical rational use of antimicrobial agents and rational use of disinfectants. METHODS Various specimens including blood, urine, sputum, pleural effusion and secretion from hospitalized patients of ICU from Jun. 2015 to Jun. 2016 were selected, and a total of 105 strains from non-repeti- tive patients were detected. The identification and drug sensitivity test for isolated strains of pathogens were per- formed using VITEK 2 Compact. RESULTS The 105 strains of P. aeruginosa had high drug resistant rates to ce- fotetan, cefazolin, sulfamethoxazole/trimethoprim, ampicillin, ampicillin/sulbactam, and nitrofurantoin, which were all higher than 95.0%. Of the isolated 105 strains, 43 strains were detected positive for qacEAl-sull gene, with the positive rate of 40.95%. CONCLUSION The condition of drug resistance of P. aeruginosa from ICU is very severe, so the surveillance over drug resistance of P. aeruginosa should be further strengthened and antibiot- ics should be used according to the results of drug sensitivity test to avoid the emergence of resistant strains. The carrier rate of qacE△1-sull of isolated P. aeruginosa is high, and the sterilization effect of common disinfectants on P. aeruginosa is good, so staffs of ICU should strictly execute the rules for disinfection and isolation, and the disinfectant-resistant gene should be detected regularly to guide the rational use of disinfectants, avoiding the ap- plication of quaternary ammonium salts and biguanide disinfectant, so as to control the occurrence of nosocomial infections.

关 键 词：铜绿假单胞菌 重症监护病房 耐药基因 消毒剂 

分 类 号：R378.991[医药卫生—病原生物学]