耐碳青霉烯类铜绿假单胞菌的耐药性及分子流行病学研究  

Antibiotic resistance and molecular epidemiology of carbapenem-resistant Pseudomonas aeruginosa

作　　者：袁莉莉[1] 丁百兴[2] 沈震[2] 吴湜[2] 徐晓刚[2] 李光辉[2] 

机构地区：[1]复旦大学附属华山医院医院感染管理科,上海200040 [2]复旦大学附属华山医院抗生素研究所,上海200040

出　　处：《中国感染与化疗杂志》2017年第3期289-292,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解耐碳青霉烯类铜绿假单胞菌(CRPA)对抗菌药物的耐药性及分子生物学特征。方法收集2013年1-12月复旦大学附属华山医院住院患者临床分离的CRPA 104株,采用琼脂稀释法对菌株行药敏测定;脉冲场凝胶电泳(PFGE)行同源性分析。结果 104株CRPA对美罗培南、亚胺培南的耐药率分别为85.6%、98.1%,对阿米卡星、庆大霉素的耐药率分别为18.3%、40.4%,对头孢他啶和头孢吡肟的耐药率分别为26.9%和21.2%,对环丙沙星和左氧氟沙星的耐药率分别为44.2%和50.0%,对哌拉西林-他唑巴坦、头孢哌酮-舒巴坦和替卡西林-克拉维酸的耐药率分别为19.2%、26.9%和52.9%,对氨曲南耐药率为26.9%,对黏菌素耐药率最低,仅为5.8%。PFGE分析存在48个型别(3株未能分型),9个克隆。克隆A是主要流行株,占41.6%(42/101),科室主要集中在神经外科、老年科及综合病房,其次为克隆B,占5.9%(6/101)。结论医院内存在耐碳青霉烯类铜绿假单胞菌的多个克隆,应采取有效的感染控制手段,加强抗菌药物临床应用管理,延缓细菌耐药性产生并阻止耐药菌进一步播散。Objective To investigate the antibiotic resistance pattern and molecular epidemiology of carbapenem-resistant Pseudomonas aeruginosa. Methods The antimicrobial susceptibility was measured by agar dilution method for the 104 strains of carbapenem-resistant P aeruginosa （CRPA） collected from Huashan Hospital. The homology between these strains was evaluated by pulsed field gel electrophoresis （PFGE）. Results Of thel04 CRPA strains, 85.6% were resistant to meropenem and 98.1% to imipenem. These strains also showed various percentages of resistance to amikacin （18.3%）, gentamicin （40.4%）, ceftazidime （26.9%）, cefepime （21.2%）, ciprofloxacin （44.2%）, levofloxacin （50.0%）, piperacillin-tazobactam （19.2%）, cefoperazone-sulbactam （26.9%）, ticarcillin-clavulanic acid （52.9%）, aztreonam （26.9%）, and colistin （5.8%）. PFGE analysis showed that these strains were divided into 48 types, belonging to 9 clones. Only 3 strains were non-typeable. Clone A was the primary epidemic strain （41.6%, 42/101）, which was mainly isolated from Neurosurgery, Geriatrics and General Ward. Clone B accounted for 5.9% （6/101） of the strains. Conclusions Multiple clones of carbapenem resistant Pseudomonas aeruginosa were prevalent in Huashan hospital. Effective infection control approaches should be adopted to prevent the development and the further spreading of antimicrobial resistance.

关 键 词：铜绿假单胞菌 碳青霉烯类耐药 耐药性 同源性分析 

分 类 号：R446.5[医药卫生—诊断学]