医院铜绿假单胞菌感染分布及耐药机制研究

Study on infection distribution and drug resistance mechanism of Pseudomonas aeruginosa in hospital

目的研究铜绿假单胞菌感染分布,对临床常用抗生素耐药情况和流行特点,为铜绿假单胞菌感染的控制和治疗提供依据。方法收集住院患者临床标本中分离出铜绿假单胞菌,采用K-B纸片扩散法扩散法测定铜绿假单胞菌对临床常用抗生素耐受水平。采用eCIM试验检测产碳青霉烯酶菌。采用PCR技术检测耐药基因和毒力基因。结果分离出84株铜绿假单胞菌,其中24株产碳青霉烯酶。耳鼻喉、ICU、普内科、心血管内科、感染内科、消化内科、综合内科、中西医结合科、儿一科、儿二科、普外科、骨一科、脑外科、泌尿肛肠科分别检出铜绿假单胞菌株数为:1、23、5、3、9、14、2、4、7、5、1、2、7和1株。24株产酶株中有16株来自ICU。碳青霉烯耐药铜绿假单胞菌对哌拉西林、庆大霉素、妥布霉素、头孢他啶、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、左氧氟沙星、氨曲南、环丙沙星、阿米卡星、头孢吡肟、亚胺培南、美罗培南、替卡西林/棒酸、多粘菌素B和诺氟沙星耐药率分别为100.00%、87.50%、87.50%、100.00%、45.83%、45.83%、79.17%、100.00%、79.17%、50.00%、100.00%、100.00%、100.00%、66.67%、12.50%和75.00%。24株碳青霉烯耐药株中共计检出17株IMP阳性,15株VIM阳性,7株SPM阳性,2株GIM阳性,7株OprD2基因缺失,6株KPC阳性。24株碳青霉烯耐药株中共计检出24株plcH阳性,24株aprA阳性、24株algD阳性、17株exoS阳性,11株exoT阳性,3株exoU阳性,17株exoY阳性、10株pys阳性和3株oaclR阳性。结论铜绿假单胞菌主要分离自ICU,产酶率最高。IMP型和VIM型是本次研究中检出最多的耐药基因型。

Objective To study the distribution of P.aeruginosa infection,drug resistance to common clinical antibiotics and epidemic characteristics,so as to provide basis for the control and treatment of P.aeruginosa infection.Method P.aeruginosa was isolated from clinical specimens of hospitalized patients and identified by automatic bacterial identification instrument.K-B disk diffusion method was used to determine the tolerance of P.aeruginosa to common clinical antibiotics.The carbapenemase producing bacteria were detected by eCIM test.PCR was used to detect drug resistance genes and virulence genes.Result 84 strains of P.aeruginosa were isolated,of which 24 strains produced carbapenemase.The number of Pseudomonas aeruginosa strains detected in Otolaryngology,ICU,general medicine,cardiovascular medicine,Infectious Medicine,Gastroenterology,general internal medicine,Department of integrated traditional Chinese and Western medicine,Department of Pediatrics,Department of Pediatrics,Department of Pediatrics,Department of general surgery,Department of orthopedics,Department of brain surgery and Department of Urology,anorectal medicine were 1,23,5,3,9,14,2,4,7,5,1,2,7 and 1 respectively.16 of the 24 enzyme producing strains were from ICU.The resistance rates of carbapenem resistant Pseudomonas aeruginosa to piperacillin,gentamicin,tobramycin,ceftazidime,piperacillin/tazobactam,cefoperazone/sulbactam,levofloxacin,aztreonam,ciprofloxacin,amikacin,cefepime,imipenem,meropenem,ticarcillin/clavulanic acid,polymyxin B and norfloxacin were 100.00%,87.50%,87.50%,100.00%,45.83%,45.83%,79.17%,100.00%,79.17%,50.00%,100.00%,100.00%,100.00%,66.67%,12.50%and 75.00%.Detection of drug resistance genes:among the 24 carbapenem resistant strains,17 strains were IMP positive,15 strains were VIM positive,7 strains were SPM positive,2 strains were GIM positive,OprD2 gene were not detected in 7 strains and 6 strains were KPC positive.Among the 24 carbapenem resistant strains,24 strains were plcH positive,24 strains were aprA positive,24 strains were algD positive,17 strains were exoS positive,11 strains were exoT positive,3 strains were exou positive,17 strains were exoY positive,10 strains were pys positive and 3 strains were oaclR positive.Conclusion P.aeruginosa isolated from ICU was the most detected,and the enzyme production rate was the highest.IMP and VIM were the most resistant genotypes detected in this study.