铜绿假单胞菌对β-内酰胺类抗生素的耐药性分析

Resistance of Pseudomonas aeruginosa to β-lactam antibiotics in Henan Zhengzhou, China

目的:分析铜绿假单胞菌对β-内酰胺类抗生素的耐药性,为今后临床用药工作提供参考。方法:选取2017年1月至2017年12月期间我院微生物室分离出的131株头孢他啶耐药(MIC≥16μg·ml^(-1))铜绿假单胞菌作为研究对象,采用梅里埃VITEK-2全自动微生物鉴定药敏系统(法国)分析铜绿假单胞菌对头孢哌酮、头孢曲松、哌拉西林/他唑巴坦、阿米卡星、头孢哌酮/舒巴坦、头孢他啶、哌拉西林、头孢吡肟、亚胺培南的耐药性特点和多重耐药情况,并通过表型确证试验对产超广谱β-内酰胺酶(Extended-spectrum-β-lactamases,ESBLs)的菌株进行筛选,并行相关耐药基因的多重PCR检测。结果:(1)研究发现,本组131株铜绿假单胞菌株中阳性率为21.37%,铜绿假单胞菌对头孢曲松、庆大霉素、氨曲南、头孢哌酮的耐药率分别为71.76%、42.75%、44.28%与49.62%,铜绿假单胞菌对哌拉西林/他唑巴坦、阿米卡星、头孢哌酮/舒巴坦、头孢他啶、左氧氟沙星、哌拉西林、头孢吡肟以及亚胺培南的耐药率均<40%。(2)金属β-内酰胺酶阳性菌株对11种抗生素的耐药率均明显高于金属β-内酰胺酶阴性菌株,具有统计学意义(P<0.05)。结论:产金属β-内酰胺酶是铜绿假单胞菌对β-内酰胺类抗生素明显耐药的主要原因,在临床治疗中要及时开展细菌培养和药敏试验,以促进合理用药,避免耐药性的发生。

Objective: To investigate the resistance of Pseudomonas aeruginosa to β-lactam antibiotics in Henan Zhegnzhou, China. Methods: A total of 131 ceftazidime-resistant (MIC≥16μg·ml -1 ) Pseudomonas aeruginosa isolates isolated from January 2017 to December 2017 in our laboratory from January 2017 to December 2017 were selected. The Pseudomonas aeruginosa was analyzed by the Mérieux VITEK-2 automatic microbial identification drug sensitivity system for cefoperazone, ceftriaxone, piperacillin/tazobactam. The drug resistance characteristics and multi-drug resistance of amikacin, cefoperazone/sulbactam, ceftazidime, piperacillin, cefepime, and imipenem, and the production of extended-spectrum β lactamase were determined by phenotypic confirmation test. Strains of extended-spectrum-β-lactamases (ESBLs) were screened by multiplex PCR detection of related drug resistance genes. Results: Among the 131 strains of Pseudomonas aeruginosa strains, metallo-β-lactamase were detected in 28 strains with the positive rate as 21.37%. The resistance rate of Pseudomonas aeruginosa to ceftriaxone was 71.76%, and 71.76%, 42.75%, and 44.28% to gentamicin, aztreonam and cefoperazone, respectively. The resistance rate of metal β-lactamase-positive strains to 11 antibiotics was significantly higher than that of metal β-lactamase-negative strains (P<0.05). Conclusion: Metal-producing β-lactamase is the main reason for the significant resistance of P. aeruginosa to β-lactam antibiotics in Henan Zhengzhou, China.