Abstract：【Objective】To analyze the characteristics of carbapenem resistant pseudomonas aeruginosa (CRPA) and the status of heterogeneous resistance to polymyxin. 【Methods】A total of 76 CRPA strains were collected. Genes related to drug resistance were detected by PCR and the sensitivity of the strains to polymyxin was also detected. Of which, 15 strains were selected for population profiling to analyze the heterogeneity of polymyxin, and the combination drug experiment was used to screen the medication plan. 【Results】Out of 76 CRPA strains, result showed that there were 15 strains (19.74%) IMP positive, 8 strains (10.53%) VIM positive, 6 starins (7.89%)SPM positive, 12 stains (15.79%)OXA-10 positive, and45 strains (59.21%) OprD2 deletion. A total of 75 strains (98.68%) were sensitive to polymyxin. Among the 15 strains of CRPA, 5 strains (33.33%) had heterogeneous resistance, 3 strains (20.00%) had heterogeneity, and 7 strains (46.67%) had no heterogeneity. The combination regimen of polymyxin with biapenem had the best effect. 【Conclusion】The production of penicillene-like enzymes and the loss of outer membrane porin are one of the main mechanisms of CRPA resistance. CRPA is highly sensitive to polymyxin with heterogeneous and heterogeneous drug resistance. Drug combination can enhance the sensitivity of heterogeneous drug-resistant strains.
[1] EKLÖF J, GLIESE K M, INGEBRIGTSEN T S, et al. Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection[J].PLoS One,2019, 14(12):e0226935.
[2] HU Y Y, CAO J M, YANG Q, et al. Risk factors for carbapenem-resistant pseudomonas aeruginosa, Zhejiang Province, China [J].Emerg Infect Dis,2019, 25(10):1861-1867.
[3] AZIMI L, FALLAH F, KARIMI A, et al. Survey of various carbapenem-resistant mechanisms of Acinetobacter baumannii and Pseudomonas aeruginosa isolated from clinical samples in Iran[J].Iran J Basic Med Sci,2020, 23(11):1396-1400.
[4] BERGEN P J. Clinically relevant plasma concentrations of colistin in combination with imipenem enhance pharmacodynamic activity against multidrug-resistant Pseudomonas aeruginosa at multiple inocula[J].Antimicrob Agents Chemother,2011, 55(11):5134-5142.
[5] MENEGUCCI T C, FEDRIGO N H, LODI F G, et al. Pharmacodynamic effects of sulbactam/meropenem/polymyxin-B combination against extremely drug resistant acinetobacter baumannii using checkerboard Information[J].Microb Drug Resist,2019, 25(9):1266-1274.
[6] CHO H H, KWON K C, KIM S, et al. Association between biofilm formation and antimicrobial resistance in carbapenem-resistant pseudomonas aeruginosa[J].Ann Clin Lab Sci,2018, 48(3):363-368.
[7] JOJI R M, AL-RASHED N, SAEED N K, et al. Detection of VIM and NDM-1 metallo-beta-lactamase genes in carbapenem-resistant Pseudomonas aeruginosa clinical strains in Bahrain[J].J Lab Physicians,2019, 11(2):138-143.
[8] SAMSUDIN F, KHALID S. Movement of Arginine through OprD: the energetics of permeation and the role of lipopolysaccharide in directing arginine to the protein[J].J Phys Chem B,2019, 123(13):2824-2832.
[9] 曾婷.耐碳青霉烯类铜绿假单胞菌耐药基因与药敏分析[J].中华医院感染学杂志, 2019, 29(20):33-37.
[10] CHEN X, XU J, ZHU Q, et al. Polymyxin B resistance rates in carbapenem-resistant Pseudomonas aeruginosa isolates and a comparison between Etest and broth microdilution methods of antimicrobial susceptibility testing[J].Exp Ther Med,2020, 20(2):762-769.
[11] 余春波, 卢明, 邵雷,等. relA基因敲除对多黏菌素抗鲍曼不动杆菌异质性耐药的影响[J].上海交通大学学报(医学版), 2019, 39(9):1004-1010.
2021, Vol. 38 
