ICU重症肺炎患者泛耐药铜绿假单胞菌的分离情况、耐药性及耐药基因检测  

Isolation,drug resistance and drug resistance gene detection of pan-drug-resistant Pseudomonas aeruginosa in ICU patients with severe pneumonia

作　　者：张伟 ZHANG Wei(Department of Laboratory Medicine,Jinan Hospital of Integrated Traditional Chinese and Western Medicine,Shandong Jinan 271100)

机构地区：[1]济南市中西医结合医院检验科,山东济南271100

出　　处：《医学检验与临床》2023年第5期31-35,共5页Medical Laboratory Science and Clinics

摘　　要：目的:分析ICU重症肺炎患者泛耐药铜绿假单胞菌(PDRPA)的分离情况、耐药性及耐药基因检测情况。方法:回顾性分析2020年6月-2021年12月在我院送检的189例ICU重症肺炎患者样本,分别采用细菌鉴定板和纸片扩散法(K-B)对病原菌进行鉴定和药敏实验,使用聚合酶链式反应(PCR)对耐药相关基因oprD2、mexC、mexR、oprM及DHA进行检测。结果:在2020年6月-2021年12月ICU重症肺炎患者样本中共检出病原菌383株,其中铜绿假单胞菌(PA)占15.67%;分离出7株PDRPA,占PA菌株11.67%;PDRPA对厄他培南耐药率达到100.00%,对头孢他啶、头孢吡、亚胺培南及左旋氧氟沙星耐药率均为85.71%,对妥布霉素、庆大霉素、氨曲南耐药率均为71.43%,对阿米卡星耐药率57.14%,对多黏菌素B耐药率为0.00%,其中对厄他培南、阿米卡星、安布霉素、庆大霉素、头孢他啶、亚胺培南及左旋氧氟沙星耐药率均明显高于MDR-PA菌株(P<0.05);PDRPA耐药基因主要以mexC、mexR、oprM为主,检测阳性率均为85.71%。结论:ICU重症肺炎患者样本中PDRPA在PA中分离率为11.67%,除多黏菌素B外,对其他9种常用抗PA药物均有较高耐药率,耐药基因主要为mexC、mexR,oprM。Objective:To analyze the isolation,drug resistance and drug resistance gene detection of pan-drug-resistant Pseudomonas aeruginosa(PDRPA)in ICU patients with severe pneumonia.Methods:A retrospective analysis was performed on the samples from the 189 ICU patients with severe pneumonia in the hospital between June 2020 and December 2021.The identification of pathogens and drug sensitivity tests were conducted by bacterial identification plate and Kirby-Bauer method(KB).The resistance-related genes(oprD2,mexC,mexR,oprM)and DHA were detected by polymerase chain reaction(PCR).Results:In the samples from ICU patients with severe pneumonia between June 2020 and December 2021,there were 383 strains of pathogens,including Pseudomonas aeruginosa(PA,15.67%).There were 7 strains of PDRPA,accounting for 11.67%of PA strains.The resistance rate of PDRPA to ertapenem was 100.00%,resistance rates to ceftazidime,cefepime,imipenem and levofloxacin were all 85.71%,resistance rates to tobramycin,gentamicin and aztreonam were all 71.43%,resistance rate to amikacin was 57.14%,and resistance rate to polymyxin B was 0.00%.The resistance rates of PDRPA to ertapenem,amikacin,tobramycin,gentamicin,ceftazidime,imipenem and levofloxacin were significantly higher than those of MDR-PA(P<0.05).The main resistance genes of PDRPA were mexC,mexR and oprM,with positive detection rate of 85.71%.Conclusion:In the samples of ICU patients with severe pneumonia,isolation rate of PDRPA in PA is 11.67%.Except for polymyxin B,PDRPA had high resistance rates to the other 9 commonly used anti-PA drugs.The main resistance genes of PDRPA are mexC,mexR and oprM.

关 键 词：肺炎 泛耐药铜绿假单胞菌 耐药性 基因 

分 类 号：R446[医药卫生—诊断学]