多发性创伤骨折术后切口感染泛耐药铜绿假单胞菌T3SS相关毒力基因表达  

Expression of T3SS-associated virulence genes in pan-resistant Pseudomonas aeruginosa with incision infection after multiple trauma fracture surgery

作　　者：曹圣芹[1] 刘保[2] 郭爱红[3] 唐晓可 常刚[5] 孙玉国[6] CAO Sheng-qin;LIU Bao;GUO Ai-hong;TANG Xiao-ke;CHANG Gang;SUN Yu-guo(Jinan Fourth People's Hospital,Jinan,Shandong 250031,China)

机构地区：[1]济南市第四人民医院手足外科,山东济南250031 [2]济南市第四人民医院医院感染管理办公室,山东济南250031 [3]济南市第四人民医院普外科,山东济南250031 [4]济南市第四人民医院导管一室,山东济南250031 [5]济南市第四人民医院脊柱外科,山东济南250031 [6]济南市第四人民医院检验中心,山东济南250031

出　　处：《中华医院感染学杂志》2023年第11期1680-1684,共5页Chinese Journal of Nosocomiology

基　　金：济南市自然科学基金资助项目(20195267)。

摘　　要：目的探讨多发性创伤骨折术后切口感染泛耐药铜绿假单胞菌Ⅲ型分泌系统(T3SS)毒力相关基因表达。方法选取2016年1月-2021年1月济南市第四人民医院203例多发性创伤骨折术后切口感染患者,通过常规微生物检验分离培养病原菌,采用聚合酶链式反应(PCR)技术对铜绿假单胞菌进行鉴定与分型,纸片扩散法测定抗菌药物敏感性。结果203例多发性创伤骨折术后切口感染患者共培养分离病原菌242株,其中革兰阴性菌181株占74.79%,革兰阳性菌61株占25.21%;共培养分离铜绿假单胞菌82株,检出T3SS阳性铜绿假单胞菌69株(84.15%);T3SS阴性菌株对头孢哌酮/舒巴坦、头孢吡肟、亚胺培南、环丙沙星的耐药率均高于T3SS阳性菌株(P<0.05);69株T3SS阳性菌株4种T3SS毒力基因中以exoT和exoY检出率最高,分别为84.06%(58/69)、81.16%(56/69),exoU-/exoS+基因型组合检出率最高,占63.77%(44/69),其次为exoU+/exoS-的26.09%(18/69),exoU-/exoS+基因型组合检出率高于exoU+/exoS-(P<0.05);exoU+/exoS-基因型对环丙沙星、庆大霉素、左氧氟沙星的耐药率高于exoU-/exoS+基因型(P<0.05)。结论T3SS阳性菌株中以exoU-/exoS+检出率最高,其次为exoU+/exoS-,exoU+/exoS-基因型对环丙沙星、庆大霉素、左氧氟沙星的耐药率高于exoU-/exoS+基因型。OBJECTIVE To investigate the expressions of virulence genes related to typeⅢsecretion system(T3SS)of pan-resistant Pseudomonas aeruginosa for postoperative incision infection after multiple trauma fracture surgery.METHODS A total of 203 patients with postoperative incision infections after multiple trauma fractures in the Forth People's Hospital of Jinan were selected between Jan.2016 and Jan.2021.The pathogenic bacteria were isolated and cultured by routine microbiological tests,Pseudomonas aeruginosa were identified and typed by polymerase chain reaction(PCR)technique,and antimicrobial susceptibility was determined by Kirby-Bauer method.RESULTS A total of 242 pathogenic strains were cultured and isolated from 203 patients with postoperative incisional infections after multiple trauma fractures,of which 181 strains of Gram-negative accounted for 74.79%,and 61 strains of Gram-positive accounted for 25.21%.A total of 82 strains of Pseudomonas aeruginosa were cultured and isolated,and 69 strains of T3SS-positive Pseudomonas aeruginosa were detected(84.15%).The T3SS-negative strains were more resistant to cefoperazone/sulbactam,cefepime,imipenem and ciprofloxacin than T3SS-positive strains to(P<0.05).Among the 4 T3SS virulence genes in 69 T3SS-positive strains,exo T and exo Y were detected at the highest rate of 84.06%(58/69),and 81.16%(56/69),respectively.The detection rate of combined genotype(exoU-/exoS+)was the highest,accounting for 63.77%(44/69),followed by exoU+/exoS-,accounting for 26.09%(18/69).The detection rate of exoU-/exoS+genotype was higher than that of exoU+/exoS-(P<0.05).The exoU+/exoS-genotype had a higher resistance rate to ciprofloxacin,gentamicin and levofloxacin than the exoU-/exoS+genotype(P<0.05).CONCLUSION Among T3SS positive strains,detection rate of exoU-/exoS+was the highest,followed by exoU+/exoS-.The exoU+/exoS-genotype was more resistant to ciprofloxacin,gentamicin and levofloxacin than the exoU-/exoS+genotype.

关 键 词：多发性创伤骨折 术后切口感染 病原学 耐药性 泛耐药铜绿假单胞菌 毒力基因 

分 类 号：R619.3[医药卫生—外科学]