福州地区多重耐药铜绿假单胞菌发现新ST型ST5030及危险因素分析  

Analysis of New ST Type ST5030 and Risk Factors of Multidrug-Resistant Pseudomonas Aeruginosa in Fuzhou Area

作　　者：谢智强 叶婷婷 刘畅 廖忠先 曹颖平[1] XIE Zhiqiang;YE Tingting;LIU Chang;LIAO Zhongxian;CAO Yingping(Department of Clinical Laboratory,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Clinical Laboratory,Jian ou Hospital,Fujian Province,Nanping 353100,China)

机构地区：[1]福建医科大学附属协和医院检验科,福州350001 [2]福建省建瓯市立医院检验科,南平353100

出　　处：《福建医科大学学报》2024年第5期345-352,共8页Journal of Fujian Medical University

基　　金：福建医科大学启航基金项目(2020QH1093);福建省科技创新联合资金项目(2023Y9199)。

摘　　要：目的分析多重耐药铜绿假单胞菌(MDR-PA)感染的危险因素、耐药基因类型及同源性,为临床合理应用抗菌药物提供一定依据。方法回顾性分析福建医科大学附属协和医院2022年6月—2023年5月收集的39例感染MDR-PA患者的临床资料和临床耐药特性,PCR检测其耐药基因和多位点序列分型(MLST),并对MDR-PA患者的临床特征和危险因素进行多因素分析。结果多因素分析结果显示,使用过喹诺酮类和四环素类抗菌药物,患有呼吸衰竭、恶性肿瘤,接受过空肠管置管或胸腔、骨髓及腹腔穿刺等,均为感染MDR-PA的危险因素(P<0.05)。39株MDR-PA菌株对莫西沙星、氨苄西林、亚胺培南和呋喃妥因的耐药率均为100.0%,对美罗培南的耐药率均为93.6%,但对多黏菌素则均为敏感。耐药基因检测结果表明,bla OXA-48基因的检出率最高(66.67%),其次是OprD2(53.85%)、bla VIM(46.15%)、bla GES(28.21%)和bla TEM(2.56%)。39株MDR-PA菌株分为12种ST型,总体以ST622(46.15%,18/39)为主,发现了1种新的ST型ST5030。结论MDR-PA感染的危险因素包括使用过喹诺酮类及四环素类抗菌药物,患有呼吸衰竭、恶性肿瘤,接受过空肠管置管或胸腔、骨髓和腹腔穿刺;MDR-PA菌株bla OXA-48基因的检出率最高;MDR-PA菌株ST型主要为ST622,且发现1种新的ST型ST5030。Objective To analyze the infection risk factors,drug-resistant gene types and homology of multidrug-resistant Pseudomonas aeruginosa(MDR-PA)infections,and to provide a scientific basis for the rational application of antibacterial drugs in clinic.Methods The relevant clinical data and clinical drug resistance characteristics of 39 patients with MDR-PA infection from Fujian Medical University Union Hospital from June 2022 to May 2023 were collected and retrospectively analyzed,and the resistance genes and multilocus sequence typing(MLST)were detected by PCR,and a multifactorial analysis was performed to analyze the clinical characteristics and risk factors of MDR-PA patients.Results The results of multifactorial analysis showed that having used quinolones and tetracycline antibiotics,suffering from respiratory failure,malignant tumors,and having received jejunostomy tube placement,thoracentesis,bone marrow aspiration,and abdominocentesis were all risk factors for infection with MDR-PA(P<0.05).The resistance rates of 39 MDR-PA strains to moxifloxacin,ampicillin,imipenem and furantoin were 100.0%,and 93.6%tomeropenem,but they were all sensitive to polymyxin.The detection rate of bla OXA-48 gene was the highest(66.67%),followed by OprD2(53.85%),bla VIM(46.15%),bla GES(28.21%)and bla TEM(2.56%).The 39 MDR-PA strains were divided into 12 ST types,with an overall predominance of ST622(46.15%,18/39),and a new ST type ST5030 was found.Conclusions The risk factors of MDR-PA infection include the use of quinolones and tetracycline antibiotics,respiratory failure,malignant tumor,jejunal tube insertion,thoracocentesis,bone marrow aspiration and abdominocentesis.The detection rate of bla OXA-48 gene in MDR-PA strain was the highest.The main ST type of MDR-PA strain was ST622,and a new ST type ST5030 was found.

关 键 词：多重耐药铜绿假单胞菌 耐药基因 多位点序列分型 福州地区 

分 类 号：R446.5[医药卫生—诊断学]