铜绿假单胞菌的临床分布、多位点序列分型及耐药性分析  

Clinical Distribution,Multi-site Sequence Typing and Drug Resistance Analysis of Pseudomonas Aeruginosa

作　　者：詹旭莉 汤建华[1] 蒲洁琨 徐鹭 刘洋 ZHAN Xuli;TANG Jianhua;PU Jiekun;XU Lu;LIU Yang(Pharmacy Department of the First Affiliated Hospital of Hebei North University,Zhangjiakou 050051,China)

机构地区：[1]河北北方学院附属第一医院药学部,河北张家口050051

出　　处：《药物生物技术》2025年第1期58-63,共6页Pharmaceutical Biotechnology

基　　金：张家口市重点研发计划项目(No.2221168D)。

摘　　要：分析铜绿假单胞菌的临床分布、多位点序列分型(MLST)及耐药性。对2021年1月至2023年12月医院患者送检样本中分离的309株铜绿假单胞菌进行临床分布分析,并开展体外药敏试验和MLST研究,以揭示铜绿假单胞菌流行趋势。各样本中共分离出铜绿假单胞菌309株:其中痰液和咽拭子占比分别为51.13%、23.30%,样本主要来源呼吸道感染;其次为伤口分泌物及脓液,占比为11.97%。309株铜绿假单胞菌共分17个ST型,其中菌株数最多的前五名:ST244共59株(19.09%),ST235共43株(13.92%),ST986共31株(10.03%),ST597共28株(9.06%),ST441共26株(8.41%)。本研究还发现2株尚未被PubMLST数据库收录的新序列分型(ST),以N1和N2表示。对2021年—2023年检出的309株铜绿假单胞菌进行药敏试验结果显示,铜绿假单胞菌分离株对3年一直使用的13种抗菌药物的耐药率整体呈下降趋势,到2023年,头孢他啶、庆大霉素、左氧氟沙星、诺氟沙星及氨卡西林/舒巴坦的耐药率基本下降到10%左右。整体来看,亚胺培南、米诺环素的耐药率最高,分别为30.42%、28.48%,其次美罗培南22.33%、哌拉西林17.80%和头孢噻肟16.50%;对阿米卡星的敏感性最高,达到91.26%;临床治疗应优先考虑阿米卡星与其他抗菌药物组合使用治疗铜绿假单胞菌。铜绿假单胞菌感染以呼吸道为主,可引起多部位感染,并对常用临床抗菌药物存在耐药性,临床治疗需科学规范用药。阿米卡星对铜绿假单胞菌敏感率高,临床治疗中优选阿米卡星与其他抗菌药物组合使用;铜绿假单胞菌进化速度快,以ST244型和ST235型为代表,临床应重点关注这两种类型的铜绿假单胞菌,以防院内爆发流行。The clinical distribution,multi-site sequence typing(MLST)and drug resistance of Pseudomonas aeruginosa(PA)were analyzed.The clinical distribution of 309 strains of PA isolated from samples sent by patients in the hospital from January 2021 to December 2023 was analyzed,and in vitro drug susceptibility test and MLST study were carried out to reveal the epidemic trend of PA.309 strains of PA were isolated from each sample,in which sputum and throat swabs accounted for 51.13%and 23.30%,respectively.The main source of the samples was respiratory tract infection.The proportion of wound secretion and pus was 11.97%.The 309 PA strains were divided into 17 ST types,among which the top five strains were 59 ST244 strains(19.09%),43 ST235 strains(13.92%),31 ST986 strains(10.03%),28 ST597 strains(9.06%)and 26 ST441 strains(8.41%).In this study,the authors also found two new sequence types(ST)that have not been included in PubMLST database,represented by N1 and N2.The drug susceptibility test results of 309 PA isolates detected from 2021 to 2023 showed that the resistance rate of PA isolates to 13 antibacterial agents used for 3 years showed a downward trend,and by 2023,the resistance rate of ceftazidime,gentamicin,levofloxacin,norfloxacin and amcarcillin/sulbactam basically dropped to about 10%.Overall,the resistance rates of imipenem and minocycline were the highest,30.42%and 28.48%,respectively,followed by meropenem 22.33%,piperacillin 17.80%and cefotaxime 16.50%.The sensitivity to amikacin was the highest,reaching 91.26%,and amikacin combined with other antibacterial agents was given priority in clinical treatment for PA.PA infection is mainly respiratory tract infection,which can cause multi-site infection and resistance to commonly used clinical antibiotics.Clinical treatment requires scientific and standardized use of drugs.Amikacin is highly sensitive to PA,and amikacin combined with other antibiotics is preferred in clinical treatment.PA evolved rapidly,represented by ST244 and ST235,and clinical attention should be

关 键 词：铜绿假单胞菌 临床分布 多位点序列分型 管家基因 耐药性 医院感染 耐药性变迁 

分 类 号：R978.1[医药卫生—药品]