老年医院分离铜绿假单胞菌的耐药性及耐消毒剂基因分析  

Analysis of drug resistance and disinfectant-resistant genes of Pseudomonas aeruginosa isolated from geriatric hospital

作　　者：李玉林 唐秋萍 董叶娜 胡洋 龙治任 苏承丹 张旬 郭紫琪 程曦[1] Li Yulin;Tang Qiuping;Dong Yena;Hu Yang;Long Zhiren;Su Chengdan;Zhang Xun;Guo Ziqi;and Cheng Xi(School of Laboratory Medicine,Chengdu Medical College,Chengdu 610500;School of Clinical Medicine,Chengdu Medical College,Chengdu 610500;Department of Laboratory Medicine,Chengdu 8th People's Hospital,Chengdu 610000)

机构地区：[1]成都医学院检验医学院,成都610500 [2]成都医学院临床医学院,成都610500 [3]成都市第八人民医院检验科,成都610000

出　　处：《中国抗生素杂志》2024年第9期1032-1037,共6页Chinese Journal of Antibiotics

基　　金：四川省大学生创新创业训练计划项目(No.S202213705057);成都医学院四川养老与老年健康协同创新中心项目(No.19Z12)。

摘　　要：目的分析老年患者分离铜绿假单胞菌(Pseudomonas aeruginosa,PA)的耐药性和耐消毒剂基因的分布情况。方法收集2019—2022年老年患者分离的111株PA,采用VITEK 2 Compact进行细菌鉴定和耐药性分析,PCR法检测耐消毒剂基因,采用SPSS 21.0对结果进行统计分析。结果15种药物中PA耐药率最高的是左氧氟沙星(30.63%),最低的是多黏菌素B(1.80%),耐碳青霉烯铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa,CRPA)占比为23.42%(26/111),多重耐药铜绿假单胞菌(multidrug-resistant PA,MDR-PA)占比为20.72%(23/111)。共检出3种耐消毒剂基因:qacE⊿1-sulΙ、emrE及merA基因,阳性率分别为16.22%(18/111)、91.89%(102/111)和46.85%(52/111),只有3株PA所有消毒剂基因均未检出。消毒剂基因携带模式最多见为模式c(41.44%,46/111);其次为模式f(36.94%,41/111)。CRPA组和非CRPA组之间、MDR组和非MDR组之间qacE⊿1-sulΙ检测阳性率具有显著差异。此外,MDR组qacE⊿1-sulΙ、emrE及merA基因同时检出的比率显著高于非MDR组。结论老年患者分离PA中携带耐消毒剂基因的比率高,携带qacE⊿1-sulΙ基因与耐药性之间可能存在一定的相关性。临床需科学合理使用消毒剂和抗菌药物,尽量减少细菌产生对两者的抗性。Objective This study investigated the drug resistance and distribution of disinfectant-resistant genes among Pseudomonas aeruginosa(PA)isolated from geriatric patients.Methods A total of 111 clinical strains of PA were isolated from geriatric patients from 2019 to 2022.The bacterial identification and antimicrobial susceptibility testing were carried out with VITEK 2 Compact.Then disinfectant-resistant genes were screened by PCR among these strains.Finally,SPSS 21.0 was used to analyze the results.Results Among the 15 drugs,levofloxaxcin had the highest drug resistance rate(30.63%)to PA,while polymyxin B had the lowest resistance rate(1.80%).The proportion of CRPA was 23.42%(26/111),and the proportion of MDR-PA was 20.72%(23/111).Three disinfectant resistance genes were detected:qacE⊿1-sulI,emrE and merA.The positive rates of the three were 16.22%(18/111),91.89%(102/111),and 46.85%(52/111),respectively.The situation where no disinfectant resistance gene was detected only occurred in three PA strains.The most common mode of carrying disinfectant resistance genes was pattern c(41.44%,46/111);next was pattern f(36.94%,41/111).There was a significant difference in the positive rate of qacE⊿1-sulI between the CRPA group and the non-CRPA group(P),and between the MDR group and the non-MDR group.In addition,the rate of simultaneous detection of qacE⊿1-sulI,emrE and merA in the MDR group was significantly higher than that in the non-MDR group.Conclusion The proportion of strains carrying disinfectant-resistant genes in PA isolated from elderly patients was high.There might be a certain correlation between carrying qacE⊿1-sulI and drug resistance.Clinical practice should require the scientific and rational use of disinfectants and antibiotics to minimize bacterial resistance to both.

关 键 词：铜绿假单胞菌 消毒剂 耐药性 老年患者 

分 类 号：R446.5[医药卫生—诊断学]