肺部感染患者多重耐药铜绿假单胞菌的耐药谱与特征

Drug resistance spectrum and characteristics of multi-drug resistant Pseudomonas aeruginosa in patients with pulmonary infection

目的了解广州市肺部感染患者分离的多重耐药铜绿假单胞菌(multi-drug resistant Pseudomonas aeruginosa,MDRPA)的耐药谱、产酶情况、耐药基因及其整合子基因的分布情况.方法对2008年-2012年在广州市某5所医院肺部感染患者中收集分离的MDRPA菌株,进行药敏试验和基因检测.结果共收集248株铜绿假单胞菌,分离MDRPA145株,多重耐药率为58.47%;对所测抗生素的耐药率均超过50.00%.MDRPA菌株产超广谱β-内酰胺酶(extended spectrum β-lactamases,ESBLs)、金属β内酰胺酶(metallo β lactamases,MBL)、C类头孢菌素酶(class Ccephalosporinases,AmpC)的检出率分别为17.93%、21.38%和17.24%;ESBLs编码基因TEM、PER、OXA-10的检出率分别为54.48%、25.52%和33.79%,MBL编码基因IMP、VIM检出率分别为21.38%、9.66%,OprD2基因缺失率为32.41%,氨基糖苷类耐药基因ant(3″)-I和aac(6′)-II检出率分别为43.45%和40.69%,I类整合子基因检出率为62.07%.结论广州市肺部感染患者铜绿假单胞菌的多重耐药现象严重,同时β-内酰胺酶及其编码基因、I类整合子基因和多种耐药基因广泛存在于MDRPA中,应引起高度重视.

Objective To analyze drug resistance spectrum,production of beta-lactamases,distribution of drug-resistant genes and integrons genes in multi-drug resistant Pseudomonas aeruginosa(MDRPA)isolated from patients with pulmonary infection in Guangzhou City.Methods Antimicrobial susceptibility testing and genetic testing were performed for MDRPA isolates,which were collected from patients with pulmonary infection in five hospitals in Guangzhou from 2008 to 2012.Results Of the 248 Pseudomonas aeruginosa isolates,the prevalance of MDRPA was 58.47%.The resistance rates to antibiotics used were over 50.00%.Among 145 MDRPA strains,the detection rate of production of extended spectrumβ-lactamases(ESBLs),metalloβlactamases(MBL)and class C cephalosporinases(AmpC)was 17.93%,21.38%,17.24%,respectively.The detection rate of encoding genes was TEM(54.48%),PER(25.52%),OXA-10(33.79%),IMP(21.38%)and VIM(9.66%),respectively,and the lacking rate of OprD2 gene was 32.41%.The detection rate of aminoglycoside modifying enzyme genes ant(3″)-I and aac(6′)-II was 43.45%and 40.69%,respectively,and class I integron gene was 62.07%.Conclu-sions The multi-drug resistance situation of Pseudomonas aeruginosa in patients with pulmonary infection in Guangzhou is serious.Meanwhile,β-lactamase and its coding genes,class I integron genes and a variety of drug resistance genes are widely found in MDRPA,which should be paid more attention to.