76例耐亚胺培南铜绿假单胞菌B类碳青霉烯酶与耐药现状研究

Investigation of class B Carbapenemase genes and drug resistance in imipenem-resistant Pseudomonas aeruginosa

目的调查耐亚胺培南铜绿假单胞菌的耐药现状及其B类碳青霉烯酶和膜孔蛋白基因的存在情况,指导临床合理使用抗菌药物。方法连续收集2012年2月至2012年8月该院临床标本中分离的耐亚胺培南铜绿假单胞菌共76株,采用聚合酶链反应技术(PCR)检测耐亚胺培南铜绿假单胞菌产碳青霉烯酶耐药基因及膜孔蛋白基因情况,并通过药物敏感试验了解耐亚胺培南铜绿假单胞菌耐药特征。结果 76株耐亚胺培南铜绿假单胞菌主要分布在神经外科ICU、神经内科ICU、烧伤科,分别占36.8%、25.0%、13.2%;所检菌株对多黏菌素B敏感,对其余9种抗菌药物均不同程度耐药;50株携带VIM基因,17株携带IMP基因,2株携带SIM基因,膜孔蛋白基因均未检出。结论耐亚胺培南铜绿假单胞菌多药耐药及泛耐药现象严重,其原因可能与多耐药基因表达及膜孔蛋白缺失有关,耐药基因以VIM、IMP为主,应加强耐药性监测,合理使用抗菌药物,防止耐亚胺培南铜绿假单胞菌的蔓延。

Objective To investigate the class B carbapenemase genes and drug resistance in imipenem-resistant Pseudomonas aeruginosa,to guide correct use of antibiotics in clinical treatment.Methods 76stains of imipenem-resistant Pseudomonas aeruginosa were isolated from hospitalized patients＇samples from Feb 2012to Aug 2012,then,6kinds of class B carbapenemase genes and porin protein oprD2gene were analyzed by PCR,the antimicrobial drug sensitivity of which were tested by K-B disc diffusion method.Results Totally 76strains of imipenem-resistant Pseudomonas aeruginosa were isolated from the neurosurgery ICU（36.8%）,neurology ICU（25.0%）,burn unit（13.2%）.Drug resistance rate of imipenem-resistant Pseudomonas aeruginosa to polymyxin B can achieve 0,the drug resistance to the other 9antibiotics were very high.50strains carried VIM gene,17strains carried IMP gene,2strains carried SIM gene and oprD2genes were all lost.Conclusion Drug resistance of imipenem-resistant Pseudomonas aeruginosa is serious,the cause of which might be mutiple resistant gene imipenem-resistant Pseudomonas aeruginosa expresses and porin protein missing,mainly to VIM and IMP.It is important to control bacterial resistance and prevent the spreading of imipenemresistant Pseudomonas aeruginosa.