铜绿假单胞菌耐药性及相关耐药基因分型情况分析

doi:10.3969/j.issn.1671-7171.2021.10.024

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摘要【目的】分析铜绿假单胞菌(PA)的耐药性及相关耐药基因分型情况。【方法】收集上海电力医院检验科分离的PA270株,分析PA对15种常用抗菌药物的敏感性,并用RT-PCR检测MexXY、MexAB耐药基因的表达情况。【结果】60岁及以上老人感染PA最多,有221例,占81.86%,其次为30～60岁,共37例,占13.70%,30岁及以下的最少,有12例,占4.44%。PA来源主要为痰液,检出率为47.04%,其次为尿液(26.67%)、创面(11.85%)和咽拭子(11.85%)。PA主要分布在呼吸内科、泌尿外科、神经内科,其中呼吸内科分布最广有81例,占30.00%。PA对抗菌药物的耐药率从高到低依次为替卡西林/棒酸(24.07%)、环丙沙星(23.70%)、左氧氟沙星(22.96%)、哌拉西林(22.59%)、头孢他啶(21.86%)、亚胺培南(19.26%)、氨曲南(19.26%)、美罗培南(18.52%)、庆大霉素(15.93%)、妥布霉素(15.56%)、头孢吡肟(11.11%)、头孢哌酮/舒巴坦(11.11%)、哌拉西林/他唑巴坦(10.37%)、阿米卡星(8.15%)和多粘菌素B(0.00%)。MexXY在30%的PA菌株中表达,MexAB在42%的菌株中表达,两者共同表达的占16%。【结论】呼吸内科病房60岁及以上老年人最易PA的感染,主动外排系统MexXY、MexAB过度表达是PA多重耐药机制之一。

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关键词 ：铜绿假单胞菌, 抗药性,细菌, 微生物敏感性试验, 基因

Abstract：【Objective】 To analyze the drug resistance and related drug resistance genotypes of Pseudomonas aeruginosa (PA). 【Methods 】 A total of 270 PA strains isolated from the laboratory department of Shanghai Electric Power Hospital were collected, the sensitivity of PA to 15 commonly used antibiotics was analyzed, and the expression of mexxy and mexab resistance genes was detected by RT-PCR. 【Results】The elderly aged 60 and above were most infected with Pseudomonas aeruginosa, 221 people, accounting for 81.86%, followed by 37 cases aged 30 ~ 60, accounting for 13.70%, and 12 cases aged 30 and below, accounting for 4.44%. The main source of PA was sputum, the detection rate was 47.04%, followed by urine (26.67%), wound (11.85%) and pharyngeal swab (11.85%). PA is mainly distributed in respiratory medicine, urology and neurology, of which 81 are most widely distributed in respiratory medicine, accounting for 30.00%. The resistance rates of PA to antibiotics from high to low were ticarcillin/clavulanic acid (24.07%), ciprofloxacin (23.70%), levofloxacin (22.96%), piperacillin (22.59%), ceftazidime (21.86%), imipenem (19.26%), aztreonam (19.26%), meropenem (18.52%), gentamicin (15.93%), tobramycin (15.56%) and cefepime (11.11%) , Cefoperazone/sulbactam (11.11%), piperacillin/tazobactam (10.37%), amikacin (8.15%) and polymyxin B (0.00%). Mexxy was expressed in 30% of PA strains, mexab was expressed in 42% of strains, and 16% of them were co expressed.【Conclusion】The elderly aged 60 and above in respiratory department ward are most vulnerable to PA infection. Overexpression of mexxy and mexab in active efflux system is one of the mechanisms of PA multidrug resistance.

Key words： Pseudomonas aeruginosa Drug Resistance, Bacterial Microbial Sensitivity Tests Genes

收稿日期: 2021-07-23

中图分类号:

R378.991

基金资助:上海电力医院科技项目 (编号:2021-05) **

通讯作者: **E-mail:gaohuali@163.com

引用本文:

马爱矿, 高华丽, 王敏, 王晓明, 李梦, 顾铮, 王晓蓉. 铜绿假单胞菌耐药性及相关耐药基因分型情况分析[J]. 医学临床研究, 2021, 38(10): 1526-1529.
MA Ai-kuang, GAO Hua-li, WANG Min, et al. Analysis of Drug Resistance and Related Drug Resistance Genotyping of Pseudomonas Aeruginosa. JOURNAL OF CLINICAL RESEARCH, 2021, 38(10): 1526-1529.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.10.024 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I10/1526