228株铜绿假单胞菌β-内酰胺酶的检测及耐药性分析  

Detection of β-lactamase in 228 strains of Pseudomonas aeruginosa and drug resistance

作　　者：宋文 孙倩楠 刘玉梅[1] 田凤鸣 尚晓倩 冯宁[1] 吕洁[1] 周璇 王晓丽[3] 马秀敏[1,2] SONG Wen;SUN Qian-nan;LIU Yu-mei;TIAN Feng-ming;SHANG Xiao-qian;FENG Ning;LYU Jie;ZHOU Xuan;WANG Xiao-li;MA Xiu-min(Clinical Medical Research Institute,State Key Laboratory of Pathogenesis,Prevention,Treatment of Central Asian High Incidence Diseases,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011;College of Basic Medicine of Xinjiang Medical University,Urumqi,Xinjiang 830011,China;不详)

机构地区：[1]新疆医科大学第一附属医院、省部共建中亚高发病成因与防治国家重点实验室,新疆乌鲁木齐830011 [2]新疆医科大学基础医学院,新疆乌鲁木齐830011 [3]新疆医科大学第二附属医院检验科,新疆乌鲁木齐830028

出　　处：《中华医院感染学杂志》2020年第2期165-169,共5页Chinese Journal of Nosocomiology

基　　金：新疆维吾尔自治区联合基金资助项目(2016D01C195)。

摘　　要：目的了解新疆医科大学第二附属医院铜绿假单胞菌临床分离株中3种主要的β-内酰胺酶(超广谱β-内酰胺酶、头孢菌素酶和金属β-内酰胺酶)携带情况,并分析其对临床常用抗菌药物耐药性。方法采用全自动细菌鉴定及药敏分析系统对临床分离株进行鉴定和药敏试验,采用K-B纸片法验证药敏结果;双纸片增效法试验检测ESBLs、三维法检测AmpC、EDTA协同试验检测MBLs。结果 228株铜绿假单胞菌中单产ESBLs菌株有37株(16.23%),单产AmpC菌株有10株(4.39%),单产MBLs菌株有2株(0.88%),同时产ESBLs及AmpC的菌株有11株(4.82%),同时产AmpC及MBLs的菌株有3株(1.32%),未检出同时产ESBLs和MBLs的菌株,同时产3种酶的菌株有12株(5.26%)。全阴性组、产1种酶、产2种酶及产3种酶的菌株对常用β-内酰胺类抗菌药物的耐药率比较差异有统计学意义(P<0.05)。且均在产3种酶组中耐药率最高。分别将每种抗菌药物在产1种酶、产2种酶及产3种酶组进行两两比较。美罗培南、氨曲南、哌拉西林的耐药率在组间比较差异无统计学意义。头孢哌酮/舒巴坦耐药率在产1种酶及产3种酶组中差异有统计学意义(P<0.05)。哌拉西林/他唑巴坦和头孢他啶产酶组比较差异有统计学意义(P<0.05)。亚胺培南耐药率在产1种酶与产3种酶组比较差异有统计学意义(P<0.05)。结论临床实验室应当注意耐药菌株产酶实验的筛选,以指导临床合理选用抗菌药物。OBJECTIVE To understand the three major types of β-lactamases(extended-spectrum β-lactamase, cephalosporinase and metallo-β-lactamase) in the clinical isolates of Pseudomonas aeruginosa in the Second Affiliated Hospital of Xinjiang Medical University and observe the drug resistance to the commonly used antibiotics. METHODS The isolated strains were identified by using automatic bacterial identification system, the drug susceptibility testing was carried out with the use of drug susceptibility analysis system, the result of the drug susceptibility testing was verified by using K-B disc method.The ESBLs were detected by double-disk synergy method, AmpC by three-dimensional method, MBLs by EDTA synergy test. RESULTS Of 228 strains of P. aeruginosa, 37(16.23%) were ESBLs-producing strains, 10(4.39%) were AmpC-producing strains, 2(0.88%) were MBLs-producing strains, 11(4.82%) were ESBLs plus AmpC-producing strains, and 3(1.32%) were AmpC plus MBLs-producing strains;the ESBLs plus MBLs-producing strains were not found, and there were 12(5.26%) strains that produced all the three types of enzymes.There were significant differences in the drug resistance rates to the commonly used β-lactams among the strains producing none of the enzymes, the strains producing one enzyme, the strains producing two enzymes and the strains producing three enzymes(P<0.05), and the drug resistance rates of the strains producing the three enzymes were the highest. As compared with the drug resistance rate to each one type of antibiotic among the strains producing one enzyme, two enzymes and three enzymes, there was no between-group difference in the drug resistance rate to meropenem, aztreonam or piperacillin;there was significant difference in the drug resistance rate to cefoperazone-sulbactam between the strains producing one enzyme and the strains producing three enzymes(P<0.05);there were significant differences in the drug resistance rates to piperacillin-tazobactam and ceftazidime among the enzyme-producing strains(P<0.05);there was

关 键 词：铜绿假单胞菌 ESBLS AMPC酶 MBLs酶 耐药 

分 类 号：R378.991[医药卫生—病原生物学]