铜绿假单胞菌产β-内酰胺酶与耐药相关性分析

Correlation analysis between β-lactamases of Pseudomonas aeruginosa and drug resistance

目的调查本院铜绿假单胞菌(PA)耐药性与产β-内酰胺酶现状,并探讨产酶与耐药之间的相关性。方法收集院内感染PA菌株112株,进行药敏、超广谱β-内酰胺酶(ESBLs)、金属β-内酰胺酶(MBL)和头孢菌素酶(Amp C)的检测。构建PA产β-内酰胺酶与耐药之间的Logistic回归方程,ROC曲线评价产酶预期概率(PRE)与多重耐药(MDR)在筛查PA产酶菌株中的价值。结果我院PA菌株对阿米卡星、美洛培南、亚胺培南、环丙沙星、哌拉西林/他唑巴坦和头孢他啶的敏感率都>70%,ESBLs、MBL和持续高产Amp C酶的阳性率分别为3.6%、8%和16.1%。PRE筛查产β-内酰胺酶菌株的灵敏度和特异度可达100%和93%,分别高于MDR的96.2%和74.4%。结论临床应加强对PA产β-内酰胺酶的监测,以Logistic回归PRE值为指标筛查产β-内酰胺酶菌株,要优于以MDR为指标。

Objective To investigate the status of drug resistance and β-lactamases of Pseudomonas aeruginosa（PA） in our hospital,and explore the correlation between them. Methods 112 strains of hospital-acquired PA were collected. Their drug-resistant phenotypes were tested by K-B method and β-lactamases,including ESBLs,MBL and Amp C,were also detected. Then the Logistic regression equation between drug resistance and β-lactamase was build to calculate predicted probability（PRE）. ROC curve was used to evaluate the value of PRE and MDR index. Results The sensitive rates of AMK,MEM,IPM,CIP,TZP and CAZ were higher then 70%,and the positive rates of ESBLs,MBL and AMPC were 3.6% 、8% and 16.1% respectively in our hospital.For screening of β-lactamase positive PA,the sensitivity and specificity of PRE index was 100% and 93%,which were higher than those of MDR index. Conclusion The clinical monitoring of PA β-lactamases should be strengthened. PRE from Logistic regression may be a better index than MDR for the screening of high-risk strains.