耐碳青霉烯酶铜绿假单胞菌的耐药性分析及碳青霉烯酶初筛试验的应用  

Analysis on drug resistance of carbapenemase-resistant Pseudomonas aeruginosa and clinical application of primary screening test for carbapenemase

作　　者：闫津津[1] 杨会林[1] 车华涛 陈娟[1] 陈霖 YAN Jin-jin;YANG Hui-lin;CHE Hua-tao;CHEN Juan;CHEN Lin(Laboratory Department,Peking University Shenzhen Hospital,Shenzhen 518000,China)

机构地区：[1]北京大学深圳医院检验科,广东深圳518000

出　　处：《广东医科大学学报》2023年第2期212-215,共4页Journal of Guangdong Medical University

摘　　要：目的了解耐碳青霉烯酶铜绿假单胞菌(CRPA)的临床分布、对抗菌药物的耐药性及携带的碳青霉烯酶基因型。方法回顾性分析北京大学深圳医院住院患者临床样本分离的61株CRPA的科室分布、标本来源及耐药情况。随机挑取36株CRPA,采用乙二胺四乙酸(EDTA)双纸片增效法和免疫层析法进行碳青霉烯酶初筛试验。结果61株CRPA主要分布ICU 24株(39.34%)、呼吸内科9株(14.75%),脑外科7株(11.48%)。其标本来源以痰液为主,共49株(80.33%)。药敏试验结果显示,亚胺培南和美罗培南的耐药率分别达100.00%和78.69%,而氨基糖苷类药物阿米卡星耐药率最低,为8.20%。61株CRPA碳青霉烯酶初筛试验检测出金属β-内酰胺酶型阳性菌株3株(1株既产丝氨酸酶又产金属酶),丝氨酸酶型阴性菌株29株;CRPA耐药基因测序结果显示,有3株CRPA携带金属β-内酰胺酶blaIMP-45基因,32株CRPA携带丝氨酸酶OXA-50基因,未检出KPC、GES丝氨酸酶型及NDM、VIM金属酶型基因。结论CRPA主要分布于ICU,以痰液标本为主,其菌株多携带丝氨酸酶OXA-50基因;应针对不同科室加强医院防控措施,临床则应根据药敏试验选择抗菌药物预防CRPA传播。Objective To analyze the clinical distribution,drug resistance and carbapenemase genotypes of carbapenemase-resistant Pseudomonas aeruginosa(CRPA).Methods The department distribution,specimen source,and drug resistance of 61 strains of CRPA isolated from clinical samples of inpatients at Peking University Shenzhen Hospital were retrospectively analyzed.Thirty-six CRPA strains were randomly selected for carbapenemase detection with EDTA double disk synergy method and immunochromatography.Results Of the 61 CRPA strains,there were 24 strains(39.34%)distributed in the ICU,9 strains(14.75%)in the respiratory department,and 7 strains(11.48%)in the department of brain surgery.Sputum was the main source of the specimens,covering a total of 49 strains(80.33%).The drug susceptibility test results showed that the resistance rates of imipenem and meropenem were 100.00%and 78.69%,respectively,and that of the aminoglycoside drug amikacin was the lowest(8.20%).The carbapenemase screening test for the 61 CRPA strains identified 3 metallo-β-lactamasepositive strains(1 of which produced both serinase and metalloenzyme),and 29 serinase-negative strains;CRPA drug resistance gene sequencing results showed that 3 CRPA strains carried metallo-β-lactamase blaIMP-45 gene and 32 CRPA strains carried serine OXA-50 gene,KPC,and no GES serine enzyme type,NDM,VIM metalloenzyme type genes were identified.Conclusion CRPA is mainly distributed in ICU,and in sputum specimens,and its strains mostly carryβ-lactamase OXA-50 drug resistance genes.Hospital prevention and control measures should be strengthened for different departments,and antimicrobial drugs should be selected according to drug susceptibility test for clinical treatment to prevent the spread of CRPA.

关 键 词：耐碳青霉烯酶铜绿假单胞菌 金属Β-内酰胺酶 丝氨酸酶 细菌耐药性 临床分布 

分 类 号：R917[医药卫生—药物分析学]