耐碳青霉烯类铜绿假单胞菌的耐药机制及特征分析  

Analysisof drug resistance mechanism and characteristics of carbon-resistant pseudomonas aeruginosa

作　　者：王亚平 麦吾丽旦·居来提 张中文 李玉珍 徐令清[1] 温伟洪[1] WANG Yaping;Maiwulidan Julaiti;ZHANG Zhongwen;LI Yuzhen;XU Lingqing;WEN Weihong(Department of Laboratory Medicine,the Sixth Affiliated Hosptal of Guangzhou Medical University,Qingyuan People’s Hospital,Qingyuan 511518,China)

机构地区：[1]广州医科大学附属第六医院、清远市人民医院,广东清远511518 [2]广东医科大学,广东东莞523000

出　　处：《现代医院》2024年第1期144-148,共5页Modern Hospitals

基　　金：广东省医学科学技术研究基金(A2021490);清远市人民医院医学科研基金支持项目(20190209,202301-201)。

摘　　要：目的探究本院耐碳青霉烯类铜绿假单胞菌(carbopenem-resistant pseudomonas aeruginosa,CRPA)的耐药机制及特征。方法用BD phoenix M50全自动鉴定药敏分析仪对菌株进行鉴定及药敏分析,微量肉汤稀释法测定头孢他啶/阿维巴坦的最低抑菌浓度(minimal inhibitory concentration,MIC),采用改良碳青霉烯类失活法(modified carbapenem inactivation method,mCIM)和胶体金免疫层析法对菌株进行碳青霉烯酶表型检测,采用全基因组测序对筛查阳性菌株进行碳青霉烯酶耐药基因检测及ST分型。结果①收集22株临床分离CRPA,其中耐药率最低的抗菌药物为头孢他啶/阿维巴坦(22.7%),然后依次为庆大霉素和阿米卡星(27.3%),哌拉西林/他唑巴坦(59.09%),头孢吡肟(63.6%),头孢他啶和氨曲南(77.27%),环丙沙星(86.36%),左氧氟沙星(95.45%)。②22株CRPA表型检测结果显示产碳青霉烯酶共5株(22.7%)。③全基因组测序结果显示,有4株ST549型CRPA携带金属β-内酰胺酶IMP-45及丝氨酸β-内酰胺酶OXA-1,OXA-50,1株为ST245型CRPA携带金属β-内酰胺酶NDM-1,即5株CRPA菌株均产金属β-内酰胺酶。结论产碳青霉烯酶不是本院CRPA对碳青霉烯耐药主要机制,CRPA对头孢他啶/阿维巴坦耐药率低且其耐药机制主要是产金属β-内酰胺酶。Objective To explore the drug resistance mechanism and characteristics of carbopenem-resistant pseudomonas aeruginosa(CRPA)in our hospital.Methods BD phoenix 100 automatic bacterial identification and drug sensitivity analyzer was used to identify and detect the drug sensitivity of the strains.The minimum inhibitory concentration(MIC)of ceftazidime/acibactam was detected by micro broth dilution method.The modified carbapenem inactivation method(mCIM)and colloidal gold immunochromatography were used to detect the carbapenemase phenotype of the strains.The whole genome sequencing was used to detect the carbapenemase resistance gene and ST typing of the screened positive strains.Results A total of 22 strains of clinically isolated CRPA were collected,of which the antibacterial drugs with the lowest resistance rate were ceftidine/avibatan(22.7%),followed by gentamicin and amikacin(27.3%),pyracillin/tazobactam(59.09%),cefuroxime(63.6%).Ceftazide and aminotransferrane(77.27%),ciprofloxacin(86.36%),levofloxacin(95.45%).There are a total of 5 strains(22.7%)of carbapenems in 22 CRPA by phenotypic detection.The whole genome sequencing results show that 4 strains of ST549 CRPA carry metalβ-lactamase IMP-45 and serineβ-lactamase OXA-1,OXA-50,one strain is ST245 CRPA carries metalβ-lactamase NDM-1,that is,all five CRPA strains produce metalβ-lactamase.Conclusion The resistance rate of CRPA to ceftazidime/avibactam is low in our hospital.Carbapenemase-producing is not the main mechanism of CRPA resistance to carbapenems,while metalβ-Lactamase-producing is the main mechanism of CRPA resistance to ceftazidime avibactam.

关 键 词：铜绿假单胞菌 碳青霉烯酶 头孢他啶/阿维巴坦 耐药特征 

分 类 号：R446.5[医药卫生—诊断学]