多重耐药铜绿假单胞菌氨基糖苷类修饰酶基因及qacEΔ1基因检测研究

Aminoglycoside modifying enzyme gene and qacEΔ1 gene of multi-resistant Pseudomonas aeruginosa

目的探讨多重耐药铜绿假单胞菌(Pa)的耐药机制,为临床使用氨基糖苷类药物治疗Pa感染和消毒灭菌工作提供参考。方法采用琼脂稀释法从临床分离的Pa中筛选出35株多重耐药菌株,用PCR方法检测这些菌株中氨基糖苷类修饰酶编码基因及qacEΔ1基因存在状况。结果35株Pa中aac(3)Ⅱ、aa(6′)Ⅱ、ant(3″)Ⅰ和ant(2″)Ⅰ等5种氨基糖苷类修饰酶基因检出率分别为48.6%、40.0%、54.3%、45.7%和60.0%,绝大多数菌株携带2种或2种以上的氨基糖苷类修饰酶基因,而qacEΔ1基因检出率也达到94.3%。结论铜绿假单胞菌产生氨基糖苷修饰酶与该菌的多重耐药有密切关系,临床治疗Pa感染应参考药敏试验结果,慎选氨基糖苷类药物;同时在消毒灭菌工作中,不宜继续使用季铵盐类、双胍类等作为常用消毒剂。

Objective To study the mechanism of resistance to antibiotics and disinfectants of Pseudomonas aeruginosa isolated from clinical specimens in a hospital, and to provide a reference for the use of aminoglycoside antibiotics for the treatment of P. aeruginosa infection as well as disinfection and sterilization. Methods 35 strains of multi-resistant P. aeruginosa were screened from clinical specimens by susceptibility test of agar dilution. Five kinds of aminoglycoside modifying enzyme gene and qzcEΔ1 gene were detected by polymerase chain reaction （PCR） method. Results The positive rates of aminoglycoside modifying enzyme genes, including aac（3）-Ⅱ, aac（6＇）-Ⅰ, aac （6＇）-Ⅱ, ant（3＂）-Ⅰ and ant（2＂）-Ⅰ, were 48. 6%, 40%, 54.3%, 45. 7% and 60%, respectively, and nearly all strains were positive for 2 or more than 2 kinds of above aminoglycoside modifying enzyme gene. The positive rate of qzcEA1 gene was 94.3%. Conclusions There was a close relationship between aminoglycoside modifying enzyme producing P. aeruginga and its multi-resistance to antibiotics, The results suugested that aminoglycosides should be used cautiously, and it should be based on the result of susceptibility test in the treatment of P. aeruginosa infection, and it was inadvisable to use quaternary ammonium and biguanides disinfectant in disinfection and sterilization.