多药耐药铜绿假单胞菌产酶相关因素的分析

Enzyme produced by multidrug-resistant Pseudomonas aeruginosa and factors for production of enzymes

目的分析医院2008-2010年多药耐药铜绿假单胞菌的产酶相关因素。方法收集医院2008-2010年住院患者送检标本检出的多药耐药铜绿假单胞菌125株,均按照美国临床实验室标准化委员会(NCCLS)推荐的纸片扩散(K-B)法,进行耐药性检测和耐药菌的确认,采用改良三维试验进行耐药铜绿假单胞菌产β-内酰胺酶表型检测,收集同时期非产酶菌100株作为对照组,采用单因素分析法分析铜绿假单胞菌产金属β-内酰胺酶相关因素;进一步采用logistic回归分析确定铜绿假单胞菌产金属β-内酰胺酶的独立危险因素。结果 125株铜绿假单胞菌中,检出产酶铜绿假单胞菌52株,检出率为41.6%;其中,产ESBLs酶35株、AmpC酶9株、MBL酶8株;其中有4株同时产MBL酶和ESBLs酶,多因素logistic回归分析结果表明,连续使用亚胺培南、联合用药和频繁更换用药是造成铜绿假单胞菌产酶的独立危险因素。结论连续使用亚胺培南时间过长、联合用药和频繁更换用药者易造成铜绿假单胞菌产ESBLs。

OBJECTIVE To explore the factors associated with production of enzymes by multi-resistant Pseudomonas aeruginosa（PAE）.METHODS A total of 125 multidrug-resistant P.aeruginosa strains isolated from inpatients specimens from Jan 2008 to Jan 2010 were collected.Detection of drug resistance and identification of these strains were performed by K-B method recommended by NCCLS.The phenotype of beta-lactamases produced by multidrug-resistant P.aeruginosa was detected by modified three dimensional test,meanwhile,100 strains of non-enzyme-producing isolates were collected and set as control group.Logistic regression analysis was further adopted to determine the independent risk factors for the production of metallo-β-lactamase by PAE.RESULTS Among 125 strains of PAE,52 enzyme-producing PAE strains were detected with the detection rate of 41.6%,including 35 ESBLs-producing strains,9 AmpC-producing strains,8 MBL-producing strains,and 4 strains were MBL-and ESBLs-producing strains.Multivariate Logistic regression analysis indicated that consecutive use of imipenem,combination use of antibiotics,and frequent drug dressing were the independent risk factors.CONCLUSION The over prolonged use of imipenem,combination use of drugs,and frequent drug dressing are the susceptible factors for the production of ESBLs.