产碳青霉烯酶铜绿假单胞菌的耐药基因检测及药敏分析

Analysis on the drug resistance genes and drug sensitivity of carbapenemase producing Pseudomonas aeruginosa

目的:研究临床分离铜绿假单胞菌产碳青霉烯酶的主要基因型和药敏分布。方法:收集2020年11月~2022年1月芜湖市中医医院住院患者微生物送检标本,培养分离铜绿假单胞菌,采用最低抑菌浓度(MIC)法检测药敏结果,胶体金及PCR法检测耐药表型及基因。结果:临床分离铜绿假单胞菌共46株,科室分布构成占比以重症医学科为主(32.6%),其次为呼吸内科(21.7%);其中碳青霉烯类耐药铜绿假单胞菌(CRPA)分布以重症医学科构成占比最高(44.4%)。46株铜绿假单胞菌对替卡西林/克拉维酸、左氧氟沙星、阿米卡星、头孢他啶、头孢吡肟、亚胺培南、黏菌素耐药率分别为26.1%、30.4%、2.2%、19.6%、13.0%、19.6%、4.3%。9株CRPA对替卡西林/克拉维酸、左氧氟沙星、阿米卡星、头孢他啶、头孢吡肟、亚胺培南、黏菌素耐药率分别为66.7%、66.7%、11.1%、55.6%、66.7%、100.0%、0%。碳青霉烯酶阳性铜绿假单胞菌基因型主要为新德里金属β内酰胺酶(NDM)型、其次为亚胺培南酶(IMP)型。结论:铜绿假单胞菌产碳青霉烯酶主要为NDM型,且耐药广泛,临床和院感应加强检测和监控。

Objective:To investigate the major genotypes and drug sensitivity distribution of carbapenemase producing Pseudomonas aeruginosa strains isolated clinically.Methods:The microbial samples were collected from the inpatients in Wuhu Traditional Chinese Medicine Hospital between November 2020 and January 2022.Pseudomonas aeruginosa was isolated and cultured.Minimum inhibitory concentration(MIC)method was used to measure the results of drug sensitivity,and the phenotypes and genotypes of drug resistance were detected by colloidal gold and PCR.Results:Forty-six strains of Pseudomonas aeruginosa were clinically isolated.The distribution proportion by department ranked from 32.6%(ICU)to 21.7%(Department of Respiratory Medicine),and Carbapenem-resistant Pseudomonas aeruginosa(CRPA)was the highest in ICU(44.4%).The drug resistance rates of the 46 strains to ticarcillin/clavulanic acid,levofloxacin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,imipenem and colistin were 26.1%,30.4%,2.2%,19.6%,13.0%,28.3%,19.6%and 4.3%,respectively.The rates of 9 CRPA strains to ticarcillin/clavulanic acid,levofloxacin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam and colistin were 66.7%,66.7%,11.1%,55.6%,66.7%,66.7%and 0%,respectively.The genotype of carbapenemase was mainly associated with NDM type,followed by IMP type.Conclusion:The carbapenemase produced by Pseudomonas aeruginosa in our hospital is mainly NDM type,and has wide drug resistance.Our findings suggest that clinical sections and department of nosocomial infection management should strengthen detection of the pathogens and monitoring over drug resistance.