耐碳青霉烯类铜绿假单胞菌耐药基因与药敏分析  

Antimicrobial susceptibility and resistance genes of carbapenem-resistant Pseudomonas aeruginosa

作　　者：曾婷 曾凌 曹先伟[3] 邓琼[3] 张杰 ZENG Ting;ZENG Ling;CAO Xian-wei;DENG Qiong;ZHANG Jie(Nanchang University,Nanchang,Jiangxi 330006,China)

机构地区：[1]南昌大学公共卫生学院,江西南昌330006 [2]江西省预防医学重点实验室,江西南昌330006 [3]南昌大学第一附属医院医院感染管理科,江西南昌330006 [4]南昌大学医学院,江西南昌330006

出　　处：《中华医院感染学杂志》2019年第20期3063-3067,共5页Chinese Journal of Nosocomiology

基　　金：江西省科技厅重点基金资助项目(20152ACG70015);江西省研究生创新专项资金资助项目(YC2018-S103)

摘　　要：目的调查医院耐碳青霉烯类铜绿假单胞菌(Carbapenem-resistant Pseudomonas aeruginosa,CRPA)的耐药特性,为指导临床抗菌药物应用、降低细菌耐药性和防控医院感染提供参考。方法收集2017年3-12月在南昌大学第一附属医院分离的CRPA 95株,检测其耐药性;聚合酶链式反应(PCR)检测碳青霉烯类相关基因及外膜蛋白基因OprD2的携带情况。结果测试菌株对亚胺培南和美罗培南的耐药率分别为97.89%和95.79%,对哌拉西林/他唑巴坦的耐药率最低为50.53%,对阿米卡星、头孢吡肟、头孢他啶、左氧氟沙星的耐药率在51%~60%间,对氨曲南、环丙沙星、哌拉西林、庆大霉素、妥布霉素、头孢哌酮/舒巴坦的耐药率均≥60%。PCR法检测出67株(70.53%)OprD2基因缺失菌株,12株(12.63%)blaGES阳性菌,10株(10.53%)blaVIM阳性菌,blaIMP、blaGIM、blaSIM、blaTEM、blaPER、blaVEB、blaOXA-10阳性菌均未检出。结论CRPA的耐药形势严峻,其耐药主要与细菌产生blaGES基因、blaVIM基因和缺失OprD2基因相关。临床应加强对CRPA的监测,合理使用抗菌药物,最大限度地降低细菌耐药。OBJECTIVE To investigate the drug resistance of carbapenem-resistant Pseudomonas aeruginosa(CRPA)in hospital in order to guide the application of clinical antibiotic,reduce bacterial resistance and prevent the nosocomial infections.METHODS A total of 95strains of CRPA isolated from the First Affiliated Hospital of Nanchang University from Mar.to Dec.2017were collected to test the drug resistance.The carrying of carbapenemrelated genes and outer membrane protein genes OprD2 were detected by polymerase chain reaction(PCR).RESULTS The resistance rates of the tested strains to imipenem and meropenem were 97.89%and 95.79%,respectively,and the lowest resistance rate to piperacillin/tazobactam was 50.53%.For amikacin,cefepime,ceftazidime and levofloxacin,the resistance rates were ranged from 51%to 60%.For aztreonam,ciprofloxacin,piperacillin,gentamicin,tobramycin and cefoperazone sulbactam,the resistance rates were all more than 60%.A total of 67(70.53%)OprD2gene-deficient strains,12(12.63%)blaGESpositive strains,10(10.53%)blaVIMpositive strains were detected by PCR.The blaIMP,blaGIM,blaSIM,blaTEM,blaPER,blaVEB,blaOXA-10positive strains were not detected.CONCLUSIONThe situation of drug resistance of CRPA is serious,and the resistance is mainly related to the carrying of blaGESand blaVIM gene and the absence of OprD2gene.Clinical monitoring of CRPA should be strengthened,and antibiotics should be rationally used to minimize bacterial resistance.

关 键 词：碳青霉烯药物 耐碳青霉烯类铜绿假单胞菌 耐药 基因 耐药率 

分 类 号：R378.991[医药卫生—病原生物学]