2017—2021年临床分离多重耐药铜绿假单胞菌的分布、耐药性变迁及OprD2基因突变分析  

Distribution, Changes of Drug Resistance and OprD2 Gene Mutation Analysis of Multidrug-Resistant Pseudomonas aeruginosa Isolated in Clinic from 2017 to 2021

作　　者：吴贤丽 祝司霞 Wu Xian-li;Zhu Si-xia(Laboratory Department of Panzhihua Central Hospital,Panzhihua 617000;Department of Pathogenic Biology and Immunology,School of Basic Medicine,Panzhihua University,Panzhihua 617000)

机构地区：[1]攀枝花市中心医院检验科,攀枝花617000 [2]攀枝花学院基础医学院病原生物与免疫学教研室,攀枝花617000

出　　处：《国外医药（抗生素分册）》2022年第6期415-420,共6页World Notes on Antibiotics

基　　金：攀枝花市指导性科技计划项目(2019ZD-S-22)。

摘　　要：目的 分析攀枝花市某三甲医院近五年多重耐药铜绿假单胞菌(MDR-PA)的临床分布特点、耐药性变化趋势及OprD2基因突变情况。方法 收集2017年1月—2021年12月该院细菌室分离的标本,采用微量肉汤法(MIC法)进行药敏实验。采用PCR法扩增OprD2基因,并与GenBank数据库进行Blast比对,采用DNAMAN软件进行基因的多序列比对。结果 共检出非重复Pseudomonas aeruginosa(PA) 1495株,其中MDR-PA 172株,平均检出率为11.5%,后四年检出率不断升高;标本来源以痰最多见(73.8%)、病房以ICU最多(30.8%),二者在后三年检出率均逐年升高;神经科检出率逐年上升趋势明显,2021年为50.0%,超过ICU的检出率。MDR-PA对头孢他啶耐药率最高(92.3%),对亚胺培南、头孢哌酮/舒巴坦的耐药率分别为36.8%、26.2%,对环丙沙星、左氧氟沙星、庆大霉素、妥布霉素、阿米卡星5年平均耐药率较低(均<20%),对阿米卡星耐药率最低,仅为5.0%。除对氨基糖苷类药物和亚胺培南的耐药率近几年有所下降外,后三年耐药率呈逐年上升趋势的有哌拉西林/他唑巴坦、头孢吡肟、头孢哌酮/舒巴坦、环丙沙星和左氧氟沙星。2017—2021年MDR-PA对哌拉西林/他唑巴坦、氨曲南、头孢吡肟、亚胺培南、庆大霉素、妥布霉素的耐药率有显著变化(P<0.001),对其余药物的耐药率无明显变化(P>0.05)。35株MDR-PA的OprD2基因均未缺失,但出现突变。结论 临床分离的MDR-PA有逐年升高趋势,应重点监控ICU和神经科的痰标本。MDR-PA对大部分抗生素的耐药性呈上升趋势。MDR-PA的耐药性可能与OprD2基因突变有关。Objective To analyze the clinical distribution characteristics, drug resistance trend and OprD2 gene mutation of multidrug-resistant Pseudomonas aeruginosa(MDR-PA) in a three-a hospital of panzhihua in recent five years. Methods MDR-PA were collected from the bacterial chamber of the hospital from Jan, 2017 to Dec, 2021.Drug sensitivity tests were conducted by using microbroth method(MIC), OprD2 gene of MDR-PA were amplified by PCR, and compared with GenBank database by using Blast comparison, and DNAMAN software was used for multi-sequence comparison of genes. Results A total of 1495 non-repeating PA strains were detected, including 172MDR-PA strains, with an average detection rate of 11.5%, which detection rate increased continuously in the last four years. The Sputum was the most common source of specimens(73.8%), and mainly came from ICU(30.8%), and the detection rate of both increased year by year in the last three years. The detection rate of neurology department showed an obvious upward trend year by year, which was 50.0% in 2021, exceeding the detection rate of ICU. The resistance rate of MDR-PA to ceftazidine was the highest(92.3%), the resistance rate to imipenem, cefoperazone/sulbactam was 36.8% and 26.2% respectively, and the average resistance rate to ciprofloxacin, levofloxacin, gentamicin, to bramycin and amikacin was lower(all <20%) in 5 years, while the resistance rate to amikacin was the lowest(only 5.0%). In addition to aminoglycoside drugs and imipenem drug resistance rate decreased in recent years, the drug resistance rate in the last three years showed an increasing trend year by year, including piperacillin/tazolpime, cefepime,cefoperazone/sulbactam, ciprofloxacin and levofloxacin. From 2017 to 2021, MDR-PA showed significant changes in drug resistance rates of piperacillin/tazobartan, amtronam, cefepime, imipenem, gentamicin and tobramycin(P<0.001),while there was no significant change in drug resistance rates of other drugs(P>0.05). The OprD2 gene of 35 strains MDR-PA was not deleted, but

关 键 词：铜绿假单胞菌 耐药性 多重耐药性 OPRD2 耐药性变迁 基因突变 

分 类 号：R978.1[医药卫生—药品]