腹透相关性腹膜炎革兰阳性致病菌及相关耐药基因的检测分析

The analysis of gram-positive bacteria and the detection of related resistance genes in peritoneal dialysis related peritonitis

目的通过探讨腹膜透析相关性腹膜炎(PDAP)革兰阳性致病菌药敏结果并检测相关耐药基因,了解本地区PDAP革兰阳性球菌相关耐药基因携带情况,以指导临床用药。方法收集2014年1月至2015年10月入住安徽医科大学第一附属医院的PDAP患者腹透液标本,进行传统培养并进行药敏试验,以革兰阳性球菌为研究分析对象,应用多重聚合酶链反应检测样品中4种耐药基因,分别为万古霉素耐药基因van A/van B/van C,一代头孢耐药基因mec A。结果 44份培养结果为革兰阳性球菌的标本中4份含有van A基因,37份携带van C基因,未检出van B基因,12份携带mec A基因,携带mec A基因的样本耐药率高于未携带基因的样本,两组差异有统计学意义(P<0.05);所选样本对头孢唑林的耐药率达63.63%,对万古霉素均敏感。结论本地区PDAP患者中以革兰阳性菌为主,携带相关耐药基因的样本表现出多重耐药,相关耐药基因在耐药机制中发挥着重要作用,因此,检测样本是否携带相关耐药基因对临床抗菌药物的选择有一定指导作用。

Objective To detect the carrying case of resistance genes and guide clinical drug use in the Gram-positive bacteria comes from the peritoneal dialysis related peritonitis( PDAP). Methods The peritoneal dialysis fluid from PDRP patients was collected in January 2014 to October 2015 admitted to the Anhui Medical University,traditional culture and drug sensitive test was inplemented,at the same time,4 kinds of resistant genes including vancomycin resistant genes( van A / van B / van C) and first generation cephalosporin resistant genes mec A gene in gran positive coccus was detected by applying multiple polymerase chain reaction. Results In the 44 specimens which are Gran positive coccus,4 contains van A genes,37 carry van C gene,12 carry mec A gene,no detection van B genes. The drug resistant rate of the samples with mec A gene were higher than those without mec A gene,difference was statistically significant( P < 0. 05). Samples of cefazolin resistant rate were 63. 63%,all of the samples were sensitive to vancomycin. Conclusions In our hospital,the PDAP patients was given priority to Gram positive bacteria,the sample carried resistance gene showed multidrug resistance,related resistant gene play an important role in the resistance mechanisms,therefore,whether the detection related resistance genes to sample had a certain guiding role on clinical drug use.