多药耐药铜绿假单胞菌耐药表型及分子流行病学调查研究

Survey and research on drug resistance phenotype and molecular epidemiology of multi-drug resistant pseudomonas aeruginosa

目的探讨该院多药耐药铜绿假单胞菌（PAE）的耐药表型及其分子流行病学特征,为医院内感染监控和制订感染控制措施提供科学依据。方法收集该院2012年9月至2013年2月临床分离的49株多药耐药PAE,采用Micro Scan Walk Away 96SI全自动微生物鉴定/药敏测试系统鉴定菌株并获得对15种抗菌药物药敏结果。利用基因外重复回文序列-聚合酶链反应（REP-PCR）对PAE进行分子分型。结果 49株多药耐药PAE,对亚胺培南的耐药率最高,为79.6%;对庆大霉素、阿米卡星、妥布霉素、头孢他啶、头孢曲松钠、头孢噻肟、头孢吡肟、氨曲南、加替沙星、环丙沙星、左氧氟沙星、哌拉西林、哌拉西林/甲巯咪唑、替卡西林/克拉维酸的耐药率在38.8%~65.3%。49株PAE的遗传相似性为0.70~1.00,经REP-PCR技术,将49株多药耐药PAE分为4型及9个亚型。结论该院多药耐药PAE耐药严重并存在克隆传播流行,及时实施医院内感染的防控策略,能有效预防多药耐药PAE的暴发和流行。

Objective To investigate the drug resistance phenotype and molecular epidemiology characteristics of multi-drug resistant pseudomonas aeruginosa（PAE） to provide the scientific basis for controlling the nosocomial infection and formulating the infection control measures. Methods Forty-nine strains of multi-drug resistant PAE in our hospital from September 2012 to February 2013 were collected and identified by the Micro Scan Walk Away 96 SI automatic microbial identification/susceptibility test system. The susceptibility results of PAE to 15 kinds of antibacterial drugs were obtained at the same time. Finally,PAE was performed the molecular typing by repetitive extragenic palindromic- polymerase chain reaction（REP-PCR）. Results Forty-nine strains of multi-drug resistant PAE had the highest resistance to imipenem（79.6%）;which to gentamicin,amikacin,tobramycin,ceftazidime,ceftriaxone,cefotaxime,cefepime,aztreonam,gatifloxacin,ciprofloxacin,levofloxacin,piperacillin,piperacillin/me thimazole,ticarcillin/clavulanate was 38.8%-65.3%. Forty-nine isolates of PAE had the genetic similarity of 0.70-1.00 and were divided into 4 types and 9 subtypes by using REP-PCR. Conclusion Multi-drug resistant PAE has serious drug-resistance and the cloned spread exists in our hospital,the timely implementation of hospital infection prevention and control strategies can effec-tively prevent the outbreaks and prevalence of multi-drug resistant PAE.