铜绿假单胞菌临床分布及耐药机制研究  

Distribution of Pseudomonas aeruginosa and its mechanism of drug resistance

作　　者：秦柯君[1] 曹献芹[1] 陈派强 郭珊[1] QIN Ke-jun;CAO Xian-qin;CHEN Pai-qiang;GUO Shan(Xinxiang Central Hospital,Xinxiang,Henan 453000,China;Zhengzhou Yihe Hospital)

机构地区：[1]新乡市中心医院,河南新乡453000 [2]郑州颐和医院

出　　处：《中国病原生物学杂志》2021年第2期224-227,共4页Journal of Pathogen Biology

摘　　要：目的分析铜绿假单胞菌分布及耐药机制,为控制菌株耐药性发展提供指导。方法收集本院患者临床送检标本,采用全自动细菌鉴定仪鉴定病原菌,并采用K-B法进行药敏试验。PCR扩增及测序检测耐药基因分布及变异情况。结果共分离289株铜绿假单胞菌,其中ICU、神经外科、呼吸内科、儿科、神经内科、胸外科、骨外科中分离菌株分别占28.03%、21.11%、17.99%、11.07%、9.00%、7.96%和4.84%。痰液、分泌物、脓液、血液、腹腔积液中分离菌株分别占59.86%、20.07%、10.03%、5.88%和4.15%。铜绿假单胞菌对头孢他啶、亚胺培南、环丙沙星、头孢吡肟、美罗培南、左氧氟沙星、哌拉西林/他唑巴坦、阿米卡星、氨曲南、庆大霉素的耐药率分别为37.02%、2.77%、33.91%、23.88%、6.23%、31.14%、29.07%、19.03%、47.75%和28.03%。93株多重耐药铜绿假单胞菌中TEM、IMP、VIM、OXA-58、armA、rmtB、aac(6′)-Ⅱ、ant(3″)-Ⅰ、oprD2缺失、gyrA突变、parC突变阳性检测率分别为17.20%、12.90%、8.60%、7.53%、21.51%、12.90%、17.20%、25.81%、12.90%、30.11%和23.66%;196株非多重耐药铜绿假单胞菌阳性检测率分别为11.22%、8.16%、6.12%、3.06%、10.71%、7.65%、12.24%、16.84%、7.65%、16.33%和10.20%。铜绿假单胞菌oprD2发生编码区395~405位11 bp片段缺失,gyrA基因发生83位氨基酸突变(Thr→Ile),parC基因发生87位氨基酸突变(Ser→Leu)。结论铜绿假单胞菌感染患者主要分布在ICU科室,痰液样本中分离率较高。耐药基因是铜绿假单胞菌多重耐药性产生的直接原因,及时监测耐药基因分布及变异情况对耐药株传播控制有重要意义。Objective To analyze the distribution and mechanism of drug resistance of P.aeruginosa in order to guide the control of drug resistance.Methods Clinical specimens were collected from patients at this Hospital,and pathogens were identified by an automated microbial identification system.A drug sensitivity test was performed using the K-B method.Amplification with PCR and sequencing were used to determine the distribution of and variation in drug resistance genes.Results A total of 289 strains of P.aeruginosa were isolated,including 28.03% from the ICU,21.11% from Neurosurgery,17.99% from Respiratory Medicine,11.07% from Pediatrics,9.00% from Neurology,7.96% from Thoracic Surgery,and 4.84% from Orthopedics.Fifty-nine-point-eight-six percent of strains were isolated from sputum,20.07% were isolated from secretions,10.03% were isolated from pus,5.88% was isolated from blood,and 4.15% was isolated from peritoneal effusion and sputum.The resistance of P.aeruginosa to ceftazidime was 37.02%,its resistance to imipenem was 2.77%,its resistance to ciprofloxacin was 33.91%,its resistance to cefepime was 23.88%,its resistance to meropenem was 6.23%,its resistance to levofloxacin was 31.14%,its resistance to piperacillin/tazobactam was 29.07%,its resistance to amikacin was 19.03%,its resistance to aztreonam was 47.75%,and its resistance to gentamicin was 28.03%.In 93 strains of multi-drug resistant P.aeruginosa,TEM was detected at a rate of 17.20%,IMP was detected at a rate of 12.90%,VIM was detected at a rate of 8.60%,oxa-58 was detected at a rate of 7.53%,armA was detected at a rate of 21.51%,rmtB was detected at a rate of 12.90%,aac(6′)-Ⅱ,was detected at a rate of 17.20%,ant(3″)-Ⅰ was detected at a rate of 25.81%,oprD2 deletion was detected at a rate of 12.90%,a gyrA mutation was detected at a rate of 30.11%,and a parC mutation was detected at a rate of 23.66%.In 196 strains of non-multi-resistant P.aeruginosa,TEM was detected at a rate of 11.22%,IMP was detected at a rate of 8.16%,VIM was detected at a rate of 6.1

关 键 词：铜绿假单胞菌 耐药基因 耐药机制 

分 类 号：R378.991[医药卫生—病原生物学]