胸外科院内感染铜绿假单胞菌耐药性与耐药机制研究  

Study on drug resistance and mechanism of Pseudomonas aeruginosa in thoracic surgery hospital

作　　者：石锋[1] 李学兆[1] 刘向前[1] 王枫[1] 华勤学[1] SHI Feng;LI Xue-zhao;LIU Xiang-qian;WANG Feng;HUA Qin-xue(Department of Thoracic Surgery,The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473058,China)

机构地区：[1]南阳医学高等专科学校第一附属医院胸外科,河南南阳473058

出　　处：《中国病原生物学杂志》2022年第10期1184-1187,共4页Journal of Pathogen Biology

基　　金：河南医学科技奖项目(No.2022-YJ-284-R01/06)。

摘　　要：目的 分析胸外科院内感染患者的病原菌分布情况、铜绿假单胞菌耐药性及耐药机制。方法 收集1 095例接受胸外科手术患者的送检标本,采用全自动细菌鉴定仪鉴定病原菌。采用K-B纸片扩散法对临床常见的12种抗生素进行药敏试验,测定52株铜绿假单胞菌的耐药性。采用PCR对18株耐氨基糖苷类铜绿假单胞菌的氨基糖苷类修饰酶基因和16SrRNA甲基化酶基因扩增,通过扩增产物分析耐药机制。结果 1 095例患者入院诊断主要为肺癌(30.32%)与食管癌(25.11%)。93例发生术后感染,感染98例次,感染率为8.49%,主要为下呼吸道感染(52.04%)。93例胸外科院内感染患者中,培养分离病原菌共115株。86株革兰阴性菌,主要为铜绿假单胞菌;22株革兰阳性菌,主要为金黄色葡萄球菌;7株真菌。52株铜绿假单胞菌对临床常见抗生素药敏试验显示,氨曲南、头孢他啶、环丙沙星、左氧氟沙星的耐药率>30%,多粘菌素B的敏感性为100.00%。52株铜绿假单胞菌中,18株对氨基糖苷类耐药,15株产氨基糖苷类修饰酶,主要为acc(6′)-Ⅱ阳性株。产氨基糖苷类修饰酶阳性基因模式主要为acc(6′)-Ⅰ+acc(6′)-Ⅱ+ant(2″)-Ⅰ+ant(3″)-Ⅰ。18株耐氨基糖苷类铜绿假单胞菌中,16SrRNA甲基化酶基因型72.22%为armA阳性。结论 本院胸外科院内感染率为8.49%,主要为下呼吸道感染,铜绿假单胞菌为主要病原菌。耐氨基糖苷类铜绿假单胞菌的耐药基因型主要为armA、acc(6′)-Ⅱ。Objective To analyze the distribution of pathogenic bacteria, drug resistance of Pseudomonas aeruginosa and the mechanism of drug resistance in patients with nosocomial infection in thoracic surgery. Method 1 095 samples of thoracic surgery patients in our hospital were collected for examination, and the pathogenic bacteria were identified by automatic bacteria identification instrument. The K-B disk diffusion method was used to test the drug sensitivity of 12 kinds of antibiotics commonly used in clinic, and the drug resistance of 52 strains of P. aeruginosa was determined. The aminoglycoside modifying enzyme gene and 16 SrRNA methylase gene of 18 aminoglycoside resistant P. aeruginosa were amplified by PCR,and the mechanism of drug resistance was analyzed by the amplified products. Result Lung cancer(30.32%) and esophageal cancer(25.11%) were the main diseases diagnosed in 1 095 patients undergoing thoracic surgery. Postoperative infection occurred in 93 cases, 98 cases were infected, the infection rate was 8.49%,mainly lower respiratory tract infection(52.04%). 115 strains of pathogenic bacteria were isolated from 93 patients with nosocomial infection in thoracic surgery. 86 gram negative bacteria, mainly P. aeruginosa;22 gram positive bacteria, mainly Staphylococcus aureus;7 fungi. The drug sensitivity test of 52 strains of P. aeruginosa to common clinical antibiotics showed that the drug resistance rate of aztreonam, ceftazidime, ciprofloxacin and levofloxacin was more than 30%,and the sensitivity of polymyxin B was 100.00%. Among the 52 strains of P. aeruginosa,18 strains were resistant to aminoglycosides, and 15 strains produced aminoglycoside modifying enzymes, mainly acc(6′)-Ⅱ positive strains. The positive gene pattern of aminoglycoside modifying enzyme was acc(6′)-Ⅰ+acc(6′)-Ⅱ+ant(2″)-Ⅰ+ant(3″)-Ⅰ. Among the 18 strains of aminoglycoside resistant P. aeruginosa,72.22% of the 16 SrRNA methylase genotypes were ARMA positive. Conclusion The nosocomial infection rate of thoracic surgery in

关 键 词：院内感染 铜绿假单胞菌 耐药性 耐药机制 

分 类 号：R378[医药卫生—病原生物学]