沿海地区耐碳青霉烯类铜绿假单胞菌耐药基因分析和同源性研究

Drug resistance gene analysis and homology study of carbapenems resistant Pseudomonas aeruginosa in coastal region

目的了解本地区临床分离耐碳青霉烯类铜绿假单胞菌IMPRPAE耐药基因和同源性,为临床治疗和流行病学调查提供理论依据。方法从台州恩泽医院收集IMPRPAE 60株,用VITEK 2 Compact仪器进行鉴定和药敏试验;采用PCR的方法检测耐药基因;采用脉冲场凝胶电泳(PFGE)进行同源性检测。结果 IMPRPAE对阿米卡星和庆大霉素的敏感率分别为68. 3%、60. 0%,对其他抗生素的敏感率均<50%。携带IMP基因10株,阳性率为16. 7%,携带VIM基因4株,阳性率为6. 8%,其他产酶基因未检出; Opr D2基因缺失31株,占51. 7%。经PFGE分析为A型、B型、C型、D型、E型、F6型,A型24株,B型14株、C型9株、D型6株、E型4株、F型3株。结论该院IMPRPAE的耐药严重,其耐药机制主要与产生VIM和IMP 2种基因型的碳青霉烯酶及膜孔蛋白Opr D2基因缺失有关; A型基因型引起医院克隆菌株的流行播散。

Objective To analyze the resistant gene and the homology of carbapenems resistant Pseudomonas aeruginosa in Taizhou,so as to provide basis for clinical anti-infection treatment and epidemiological investigation.Methods Sixty strains of carbapenems resistant Pseudomonas aeruginosa (IMPRPAE)were collected from Taizhou Enze Hospital,and VITEK-2 Compact was used to identify the isolated strains and test their drug sensitivities;resistant genes were detected by PCR.The homologies of the 60 isolated strains were analyzed by pulse field gel electrophoresis (PFGE).Results The resistant rates of the 60 IMPRPAE strains to amikacin and gentamicin were 68.3% and 60.0%,respectively.These Pseudomonas aeruginosa isolates showed drug resistance under 50%to other antibiotics.The positive rates of VIM and IMP were 6.8%(4 strains), 16.7%(10 strains),and other genes producing enzyme were not found.The absent rate of OprD2 was 51.7%(31 strains). According to PFGE analysis,the isolates were divided into A type (24 strains),B type (14 strains),C type (9 strains),D type (6 strains),E type(4 strains),F6 type(3 strains).Conclusion The antimicrobial resistance of IMPRPAE is very serious in the hospital,and the drug resistance mechanism is mainly related to the carbapenemase producing VIM and IMP and the deletion of membrane pore protein OprD2 gene.Type A genotypes caused widespread of cloned strains in hospital.