重症监护病房耐亚胺培南铜绿假单胞菌耐药机制和分子分型的研究  

Antimicrobial resistance mechanism and molecular subtyping of imipenem-resistant Pseudomonas aeruginosa isolates in intensive care units

作　　者：周勇[1] 和鹏[1] 侯水平[1] 陶霞[1] 张晶[1] 胡玉山[1] 吴新伟[1] ZHOU Yong;HE Peng;HOU Shui-ping;TAO Xia;ZHANG Jing;HU Yu-shan;WU Xin-wei(Microbiology Testing Laboratory,Guangzhou Center for Disease Control and Prevention,Guangzhou,Guangdong 510440,China)

机构地区：[1]广州市疾病预防控制中心微生物检验部,广东广州510440

出　　处：《实用预防医学》2021年第4期446-449,共4页Practical Preventive Medicine

基　　金：广州市医学重点学科建设项目(No.2017-2019-07)。

摘　　要：目的分析重症监护病房(intensive care unit,ICU)耐亚胺培南铜绿假单胞菌的耐药特征及其耐药机制。方法收集2018年1月—2019年9月广州市某医院ICU分离的37株耐亚胺培南铜绿假单胞菌(imipenem resistant Pseudomonas aeruginosa,IRPA),使用微生物鉴定药敏分析系统分析菌株的抗菌药敏感性,脉冲场凝胶电泳(pulsed-field gel electrophoresis,PFGE)进行聚类分析,PCR检测金属β-内酰胺酶基因以及oprD2基因,并对阳性株进行测序。结果37株IRPA的抗菌药敏感性结果显示对β-内酰胺类抗生素的耐药率均很高,而氨基糖苷类和喹诺酮类抗菌药的耐药率很低。37株IRPA有11株检出携带金属酶基因,其中7株blaVIM-2,4株blaIMP-9。oprD2缺失和有意义突变合计33株,占89.2%。PFGE分析结果显示菌株高度克隆多样性,但携带金属酶基因的11株菌被分成了两个带型簇。结论本实验证实oprD2基因缺失,发生有义突变,是铜绿假单胞菌对亚胺培南耐药的主要机制;携带blaVIM-2和blaIMP-9的IRPA菌株有在ICU引起暴发流行的风险。Objective To analyze the antimicrobial resistance characteristics and mechanisms of imipenem-resistant Pseudomonas aeruginosa isolates in intensive care units(ICUs).Methods Thirty-seven imipenem-resistant Pseudomonas aeruginosa isolates were obtained from ICUs of a hospital in Guangzhou from January 2018 to September 2019.The minimum inhibitory concentrations(MICs)of the isolates were determined by microbial identification and drug sensitivity analysis system.Pulsed-field gel electrophoresis(PFGE)was used to perform clustering analysis.Polymerase chain reaction(PCR)was applied to determining metallo-β-lactamase(MBL)production and oprD2 gene,and the positive isolates were sequenced.Results All 37 IRPA isolates were resistant to the most beta-lactam antibiotics,but susceptible to aminoglycosides and quinolones.Eleven of the 37 IRPA isolates were MBL producers,including 7 isolates with blaVIM-2 and 4 isolates with blaIMP-9.The sequencing results of oprD2 showed that the disrupted oprD2 mutations rate was as high as 89.2%(33/37).PFGE revealed a high level of clonal diversity,but there were two clones represented in 11 MBL producers.Conclusions This study confirmed that imipenem resistance was driven by oprD2 inactivation.The IRPA isolates carrying blaVIM-2 or blaIMP-9 may be prevalent in ICUs.

关 键 词：铜绿假单胞菌 亚胺培南 耐药 金属Β-内酰胺酶 oprD2基因 脉冲场凝胶电泳 

分 类 号：R378.991[医药卫生—病原生物学]