碳青霉烯耐药铜绿假单胞菌的耐药特点和多位点序列分型  

The drug resistance characteristics and multilocus sequence typing of carbapenem-resistant Pseudomonas aeruginosa

作　　者：武文君[1] 王炜[2] 荆鹏伟[1] 任伟宏[1] WU Wenjun;WANG Wei;JING Pengwei;REN Weihong(Department of Laboratory,The First Affiliated Hospital of He'nan University of Chinese Medicine,Zhengzhou,He'nan 450000,China;Department of Infection Management,The First Affiliated Hospital of He'nan University of Chinese Medicine,Zhengzhou,He'nan 450000,China)

机构地区：[1]河南中医药大学第一附属医院检验科,河南郑州450000 [2]河南中医药大学第一附属医院感染控制科,河南郑州450000

出　　处：《安徽医药》2025年第1期131-136,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的了解临床分离碳青霉烯(亚胺培南、美罗培南)耐药的铜绿假单胞菌(carbapenem resistant pseudomonas aeruginosa,CRPA)的耐药情况和遗传分型,为临床合理化用药和医院感染控制工作提供依据。方法收集2021年7月至2022年6月河南中医药大学第一附属医院临床分离的非重复碳青霉烯耐药的铜绿假单胞菌60株进行鉴定和药敏试验,分析临床分布和标本来源。随机选取其中35株CRPA,利用多位点序列分型(multilocus sequence typing,MLST)扩增铜绿假单胞菌的7个管家基因acsA、aroE、guaA、mutL、nuoD、ppsA和trpE,PCR扩增测序后采用DNAstar和PHYLOViZ 2.0等软件对分离的CRPA进行遗传差异性分析。结果60株CRPA主要分布在呼吸科、康复科、重症监护病房。标本类型以痰液为主(63.3%),其次为肺泡灌洗液(28.3%)。除多黏菌素、阿米卡星、庆大霉素外,对其他抗菌药物的耐药率均为40%以上,与同期分离的碳青霉烯敏感铜绿假单胞菌(carbapenem sensitive pseudomonas aeruginosa,CSPA)相比,除多黏菌素外,CRPA分离组对阿米卡星(23.3%)、头孢吡肟(58.3%)、头孢他啶(48.3%)、环丙沙星(55.0%)、哌拉西林/他唑巴坦(45.0%)、氨曲南(56.7%)、美罗培南(78.3%)等抗菌药物的耐药率显著高于CSPA组,差异有统计学意义(P<0.05)。MLST分析显示35株CRPA可分为25个ST型,其中优势ST为ST1182。该研究发现1种新的等位基因trpE316,3种新的ST型别,分别为ST3978、ST3979、ST3980。结论CRPA主要来源于呼吸道,多见于呼吸科,CRPA耐药形势严峻,应结合药敏结果和流行病学分析,有针对性地采取干预措施。MLST分析的结果显示ST型存在多样化,克隆类型多样化,提示这些菌株的遗传背景也极其复杂多变。Objective To investigate the clinical distribution and genetic phenotypes of carbapenem-resistant Pseudomonas aeruginosa(CRPA),and provide basis for clinical rational drug use and nosocomial infection control.Methods Sixty strains of non-repeated carbapenem-resistant aeruginosa isolated clinically from July 2021 to June 2022 were collected from The First Affiliated Hospital of He´nan University of Chinese Medicine for identification and drug sensitivity testing,and the clinical distribution and source of specimens were analyzed.Thirty five CRPA strains were randomly selected,and the seven housekeeping genes acsA,aroE,guaA,mutL,nuoD,ppsA and trpE of Pseudomonas aeruginosa were amplified using the multi-locus sequence typing method(MLST),and the PCR amplification and sequencing were used to analyze the genetic variability of the isolated CRPAs using software such as DNAstar and PHYLOViZ 2.0.Results Sixty CRPA strains were mainly isolated from the respiratory department,rehabilitation department,and ICU,the main type of specimen was sputum(63.3%).The resistance rates to antibiotics were more above 40%,except polymyxin,amikacin and gentamicin.Compared with carbapenem-susceptible Pseudomonas aeruginosa(CSPA)isolated during the same period,the CRPA strains had significantly higher resistance rates to antibiotics such as amikacin(23.3%),cefepime(58.3%),ceftazidime(48.3%),ciprofloxacin(55.0%),piperacillin/tazobactam(45.0%),aztreonam(56.7%),and meropenem(78.3%),except polymyxin,and the difference was statistically significant(P<0.05).MLST analysis showed that 35 CRPA strains belonged to 25 different ST types,of which the dominant STs was ST1182.In this study,a new allele trpE316,three new ST phenotypes,ST3978,ST3979 and ST3980 were identified.Conclusions Respiratory tract infection is the main cause of CRPA in this study,which is more common in the respiratory department.The CRPA resistance situation is serious,and targeted interventions should be taken in conjunction with drug sensitivity results and epidemiological ana

关 键 词：铜绿假单胞菌 碳青霉烯类 耐药性 多位点序列分型(MLST) 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]