社区医疗机构多重耐药铜绿假单胞菌产金属β内酰胺酶检测

Detection of metallo-β-1actamase production in multi-drug resistant Pseudomonas aeruginosa incommunity medical institutions

目的了解多重耐药铜绿假单胞菌（MRPA）的社区感染情况及产金属13内酰胺酶（MBL）情况。方法2011年1月至12月在广州市多个社区医院收集分离出MRPA54株。采用Micro Scan WalkAway40SI全自动细菌鉴定与药敏检测系统检测其对亚胺培南等11种抗菌药物的耐药性，比较亚胺培南耐药铜绿假单胞菌与亚胺培南敏感铜绿假单胞菌对常用9种抗菌药物的耐药率。改良三维实验分析亚胺培南耐药铜绿假单胞菌产MBL情况。结果54株MRPA中有29株对亚胺培南耐药，占53．7％（29／54）。三维试验显示有9株亚胺培南耐药铜绿假单胞菌产MBL，占31．0％（9／29）。亚胺培南耐药铜绿假单胞菌对常用7种抗菌药物的耐药率显著高于亚胺培南敏感铜绿假单胞菌（头孢他啶：65．5％比36．0％；头孢噻肟：89．7％比44．0％；头孢曲松：100．0％比52．0％；氨曲南：72．4％比36．0％，氧氟沙星：70．0％比32．0％；哌拉西林-他唑巴坦：58．6％比16．0％；阿米卡星：62．1％比32．0％，均P〈0．05）。结论社区医疗机构临床分离MRPA产MBL的比率较高。

Objective To investigate the infection status and metallo-β-1actamase （MBL） production of multi-drug resistant Pseudomonas aeruginosa （MRPA） in community medical institutions. Methods A total of 54 MRPA trains were isolated from multiple community medical institutions in Guangzhou between January and December 2011. The drug-resistance to 11 types of antibiotics, including imipenem, was tested by using MicroScan Walk Away 40SI automatic bacteria identification and drug sensitivity testing system. The resistance of imipenem-sensitive and -resistant Pseudomonas aeruginosa to nine common antibiotics was compared. Production of MBL in imipenem-resistant Pseudomonas aeruginosa was analyzed via modified three-dimensional experiment. Results Of 54 MRPA strains, 29 （53.7%） were resistant to imipenem. There were a total of 9 imipenem-resistant Pseudomonas aeruginosa strains （9/29, 31.0%） that produced MBL, as revealed by three- dimensional experiment. Imipenem-resistant Pseudomonas aeruginosa yielded higher resistance rate to seven types of common antibiotics（ceftazidime： 65.5% vs 36.0%; cefotaxime： 89.7% vs 44.0%; ceftriaxone： 100.0% vs 52.0%; aztreonam： 72.4% vs 36.0%; ofloxacin： 70.0% vs 32.0%; piperacillin-tazobactam： 58.6% vs 16.0%; amikacin： 62.1% vs 32.0%, all P〈0.05） as compared with imipenem-sensitive Pseudomonas aeruginosa. Conclusion The ratio of MBL-production from clinical isolated MRPA is higher in community medical institutions.