重症肺炎革兰阴性菌分离株耐药性及其碳青霉烯酶基因检测  

Carbapenemase genes in drug-resistant gram-negative bacteria isolated from patients with severe pneumonia

作　　者：达明冬[1] 杨海明[2] 司立宁[1] 史雪霞[1] 李胜学[1] DA Ming-dong;YANG Hai-ming;SI Li-ning;SHI Xue-xia;LI Sheng-xue(Qinghai University Affiliated Hospital,Xining,Qinghai 81o0l,China)

机构地区：[1]青海大学附属医院感染性疾病科,青海西宁810001 [2]青海大学附属医院介入诊疗科,青海西宁810001

出　　处：《中华医院感染学杂志》2023年第18期2733-2736,共4页Chinese Journal of Nosocomiology

基　　金：青海省科学技术厅应用基础研究项目(2022-ZJ-754)。

摘　　要：目的分析重症肺炎革兰阴性菌分离株的耐药性及碳青霉烯酶耐药基因携带情况,为临床治疗提供依据.方法选取2016年1月-2021年7月青海大学附属医院收治的81例革兰阴性菌感染所致重症肺炎患者,分析检出革兰阴性菌的分布特征及耐药性,聚合酶链式反应(PCR)检测碳青霉烯酶耐药基因携带情况.结果81例患者共分离出157株病原菌,鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌为主要致病菌,分别占比46.50%、26.75%、12.10%;鲍氏不动杆菌对氨苄西林、氨曲南耐药率均为100.00%,对碳青霉烯类抗菌药物耐药率均为60.27%;铜绿假单胞菌对氨苄西林、哌拉西林耐药率均为100.00%,对碳青霉烯类抗菌药物耐药率均为57.89%;肺炎克雷伯菌对氨苄西林、头孢西丁、妥布霉素、头孢曲松耐药率均为100.00%,对碳青霉烯类抗菌药物耐药率均为35.71%;共检出碳青霉烯酶耐药菌株70株,KPC、OXA23、OXA51、NDM及VIM-2耐药基因携带率分别为21.43%(15/70)、47.14%(33/70)、47.14%(33/70)、7.14%(5/70)、4.29%(3/70).结论革兰阴性菌中鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌为重症肺炎患者感染的主要致病菌,且KPC、OXA23、OXA51基因的携带可能是以上致病菌耐碳青霉烯类药物的主要机制.OBJECTIVE To analyze drug resistance of the gram-negative bacteria isolated from the patients with severe pneumonia and observe the carbapenemase resistance genes so as to provide guidance for clinical treatment.METHODS A total of 81 patients with gram-negative bacteria infection-induced severe pneumonia who were treated in Qinghai University Affiliated Hospital from Jan 2016 to Jul 2021 were enrolled in the study.The distribution and drug resistance of the gram-negative bacteria isolates were observed,and the carbapenemase resistance genes were detected by using polymerase chain reaction(PCR).RESULTS Totally 157 strains of pathogens were isolated from the 8l patients.Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were the predominant species of pathogens,accounting for 46.50%,26.75%and 12.10%,respectively.The drug resistance rates of the A.baumanni strains to ampicillin and aztreonam were 100.00%,and the drug resistance rates to carbapenems were 60.27%;the drug resistance rates of the P.aeruginosa strains to ampicillin and piperacillin were 100.00%,and the drug resistance rates to carbapenems were 57.89%;the drug resistance rates of the K.pneumoniae strains to ampicillin,cefoxitin,tobramycin and ceftriaxone were 100.00%,and the drug resistance rates to carbapenems were 35.71%.A total of 70 strains of carbapenemase-resistant isolates were detected,and the carrying rates of drug resistance genes KPC,OXA23,OXA51,NDM and VIM-2 were 21.43%(15/70),47.14%(33/70),47.14%(33/70),7.14%(5/70)and 4.29%(3/70),respectively.CONCLUSION Among the gram-negative bacteria,A.baumannii,K.pneumoniae and P.aeruginosa are the predominant species of pathogens causing the infection in the patients with severe pneumonia.The carrying with KPC,OXA23 and OXA51 genes may be the major mechanism for resistance to carbapenems.

关 键 词：革兰阴性菌 重症肺炎 耐药菌株 碳青霉烯酶 基因检测 

分 类 号：R378[医药卫生—病原生物学]