重症监护室耐亚胺培南铜绿假单胞菌的耐药性及耐药机制研究

Antibiotic Susceptibility and Resistant Mechanism of Clinical Imipenem-resistant Pseudomonas aeruginosa in ICU

目的分析2017~2019年某县人民医院重症监护室(ICU)耐亚胺培南铜绿假单胞菌(IRPA)的耐药性及耐药机制,为耐药株的治疗和控制其蔓延提供依据。方法采用美国BD凤凰100全自动微生物分析系统检测26株IRPA的药敏,使用PCR方法对金属酶基因VIM、IMP;主动外排系统基因MexA、MexB、OprM;外膜蛋白OprD2基因进行检测。结果 26株IRPA仅多粘菌素B均敏感,对美罗培南的耐药率高达88.5%,其他9种抗菌药物的耐药率低于54%。26株均未检出VIM、IMP,均检出MexA、MexB、OprM,16株未检出OporD2。结论该院ICU IRPA主要耐药机制是MexA、MexB、OprM外排泵系统基因和高表达混合编码膜孔蛋白OporD2基因缺失。

OBJECTIVE To analyzed the drug resistance and resistance mechanism of imipenem-resistant pseudomonas aeruginosa(IRPA)in ICU of Huidong people′s hospital from 2017 to 2019,provide evidences for the treatment and control of drug-resistant strains.METHODS The drug resistance of 26 strains of IRPA was detected by BD phoenix 100 automatic microbial analysis system.The genes related to imipenem resistance(metal enzyme gene IMP and VIM,efflux pump gene MexA,MexB and OprM,outer membrane protein gene OprD2)were detected by PCR.RESULTS The 26 strains of IRPA were only sensitive to polymyxin B,and the drug resistance rate of meropenem was up to 88.5%,and the drug resistance rate of other 9 antibacterial drugs was less than 54%.VIM and IMP were not detected in 26 strains,MexA,MexB and OprM were detected in all,and OporD2 was not detected in 16 strains.CONCLUSION The main mechanism of IRPA resistance in ICU of this hospital is the deletion of the mesoporous protein OporD2 gene encoded by the high expression of genes in MexA,MexB and OprM efflux pump system.