ICU呼吸道铜绿假单胞菌耐药性及其耐药基因分型研究  

Study on the drug resistance of Pseudomonas aeruginosa from the respiratory tract in the ICU and its drug resistance genotyping

作　　者：王丽霞[1] 王运昌 李荣荣 张洁莉[1] 安静 李妤蓉[1] WANG Li-xia;WANG Yun-chang;LI Rong-rong;ZHANG Jie-li;AN Jing;LI Yu-rong(Department of Laboratory Medicine, the Second Affiliated Hospital of Xingtai Medical College, Hebei Province, Xingtai 054001, China;Department of Special Eye Examination, Xingtai Eye Hospital, Hebei Province, Xingtai 054001, China;Department of Glaucoma, Xingtai Eye Hospital, Hebei Province, Xingtai 054001, China)

机构地区：[1]邢台医学高等专科学校第二附属医院检验科,河北邢台054001 [2]河北省邢台市眼科医院眼特检科,河北邢台054001 [3]河北省邢台市眼科医院青光眼科,河北邢台054001

出　　处：《河北医科大学学报》2021年第6期708-712,共5页Journal of Hebei Medical University

基　　金：河北省邢台市科技计划项目(2019ZC119)。

摘　　要：目的探讨重症监护室(intensive care unit,ICU)中铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染的耐药情况和耐药基因分型特点,为临床治疗提供参考依据。方法收集邢台医学高等专科学校第二附属医院ICU病房送检的临床标本中分离的PA,药物敏感性试验检测PA对抗菌药物的敏感性,聚合酶链式反应(polymerase chain reaction,PCR)法检测耐药基因型。结果筛选出纳入本研究的下呼吸道PA菌株42株。PA对阿米卡星、妥布霉素、亚胺培南和多黏菌素B的耐药率在30%以下,对庆大霉素、左氧氟沙星、哌拉西林、他唑巴坦、头孢吡肟和头孢他啶的耐药率在30.0%~40.0%之间,对环丙沙星、美罗培南和氨曲南的耐药率达40.0%以上,对多粘菌素B的耐药率为0%,敏感率为100%;超广谱β-内酰胺酶相关耐药基因blaCTX-M-1基因携带率为7.1%(3/42),碳青霉烯类相关耐药基因中blaIMP基因携带率为19.0%(8/42),blaOXA-1基因携带率为16.7%(7/42),氨基糖苷类相关耐药基因aac(6′)-Ⅰb基因携带率为23.8%(10/42),ant(2″)-Ⅰa基因携带率为19.0%(8/42),外排泵基因OprD2缺失率为19.0%(8/42),Ⅰ类整合子(Int-Ⅰ)携带率为23.8%(10/42)。结论ICU病房PA感染以呼吸道为主,除阿米卡星、妥布霉素、亚胺培南和多黏菌素B外,对其他药物的耐药率均较高,应依据药敏实验合理使用抗菌药物。PA相关耐药基因以aac(6′)-Ⅰb和Ⅰ类整合子为主,有利于研究耐药逆转机制。Objective To investigate the drug resistance of Pseudomonas aeruginosa(PA)infection and characteristics of drug resistance genotyping in intensive care unit(ICU),and to provide reference for clinical treatment.Methods The PA isolated from clinical specimens submitted for examination in the ICU ward of the Second Affiliated Hospital of Xingtai Medical College was collected.The sensitivity test was used to detect the sensitivity of PA to antibacterial drugs,and the drug-resistant genotype was detected by polymerase chain reaction(PCR).Results A total of 42 strains of PA strains from lower respiratory tract were screened for this study.The resistance rate of PA to amikacin,tobramycin,imipenem and polymyxin B was less than 30%.The resistance rate to gentamicin,levofloxacin,piperacillin,tazobactam,cefepime and ceftazidime was between 30.0%and 40.0%,the resistance rate to ciprofloxacin,meropenem and aztreonam was more than 40.0%,and to polymyxin B was 0.0%,and the sensitivity rate was 100%.The blaCTX-M-1 gene carrying rate of the extended-spectrumβ-lactamase-related resistance gene was 7.1%(3/42),the blaIMP gene carrying rate of the carbapenem-related resistance genes was 19.0%(8/42)),and blaOXA-1 gene carrying rate was 16.7%(7/42).Carrying rate of Aminoglycoside-related drug resistance gene carrying aac(6′)-Ⅰb gene was 23.8%(10/42),and that carrying ant(2″)-Ⅰa was 19.0%(8/42).The efflux pump gene OprD2 deletion rate was 19.0%(8/42),and the classⅠintegron carrying rate was 23.8%(10/42).Conclusion PA infections in ICU wards are mainly found in the respiratory tract.Except for amikacin,tobramycin,imipenem and polymyxin B,the resistance rate to other drugs is relatively high,and antibacterial drugs should be used rationally based on drug sensitivity tests.PA-related drug resistance genes are mainly aac(6′)-Ⅰb and classⅠintegrons,which are conducive to the study of resistance reversal mechanisms.

关 键 词：铜绿假单胞菌 呼吸道感染 基因分型技术 

分 类 号：R978.4[医药卫生—药品]