胸外科患者医院感染铜绿假单胞菌的耐药性变化及耐药机制分析

发布时间：2018-12-06 14:46

【摘要】：目的分析胸外科患者医院感染铜绿假单胞菌的耐药性变化情况及耐药机制,为控制铜绿假单胞菌耐药性发展提供参考。方法分离自胸外科患者铜绿假单胞菌300株,其中2013年87株,2014年92株,2015年121株,采用K-B法测定菌株的耐药性,通过PCR检测菌株的耐药基因,扩增产物纯化后进行测序分析。结果 2013年铜绿假单胞菌分离株对头孢他啶、头孢吡肟、哌拉西林、庆大霉素、阿米卡星、氨曲南、环丙沙星、亚胺培南耐药率分别为16.09%、26.44%、31.03%、36.78%、11.49%、41.38%、22.99%和6.90%,2014年分离株分别为31.52%、42.39%、32.61%、41.30%、17.39%、43.48%、38.04%和10.87%,2015年分离株分别为47.11%、51.24%、36.36%、53.72%、23.97%、42.98%、52.07%和14.05%。PCR扩增oprD、IMP、mexT、nfxB基因大小分别为1 340、412、638和827bp。69株铜绿假单胞菌的IMP基因发生突变,突变率为23%,其基因突变发生在密码子的第640位,基因突变类型为A→G;相应氨基酸突变位点为第214位,氨基酸突变类型为Ser→Gly。51株铜绿假单胞菌的OprD基因发生缺失,缺失突变率为17%。141株铜绿假单胞菌的mexT基因发生突变,基因突变率为47%,其突变类型为26位氨基酸(Leu→Val)。84株铜绿假单胞菌的nfxB基因发生突变,基因突变率为28%,其突变类型为82位氨基酸(Arg→Leu)。结论胸外科患者医院感染铜绿假单胞菌对常用抗菌药物均不同程度耐药,且铜绿假单胞菌耐药基因的突变与细菌耐药性有一定关系。
[Abstract]:Objective to analyze the drug resistance of Pseudomonas aeruginosa in chest surgery patients with nosocomial infection and to provide reference for controlling the drug resistance of Pseudomonas aeruginosa. Methods 300 strains of Pseudomonas aeruginosa were isolated from thoracic surgery patients, among which 87 strains were isolated in 2013, 92 strains in 2014 and 121 strains in 2015. The drug resistance of the strains was determined by K-B method, and the resistant genes were detected by PCR. The amplified products were purified and sequenced. Results the resistance rates of Pseudomonas aeruginosa isolates to ceftazidime, cefepime, piperacillin, gentamycin, amikacin, aztreonam, ciprofloxacin and imipenem in 2013 were 16.09, 26.44 and 31.03, respectively. 36.78: 11.491.38, 22.99% and 6.90%, 31.52% and 42.39%, respectively, in 2014. There were 41.30%, 17.39%, 43.48%, 38.04% and 10.87%, respectively. The number of strains isolated in 2015 was 47.11 and 51.24, respectively, and the amount of 36.36 yuan was 53.72 and 23.97% and 42.98%, 52.07% and 52.07%, respectively, and the 14.05%.PCR amplification was 52.07%. The IMP gene of Pseudomonas aeruginosa with the size of 1 340412638 and 827bp.69 strain was mutated with a mutation rate of 23. The mutation occurred at the 640th position of the codon. The corresponding amino acid mutation site was 214th. The amino acid mutation type was OprD gene deletion in Pseudomonas aeruginosa of Ser Gly.51 strain, and the deletion mutation rate was 17.141 mexT gene mutation in Pseudomonas aeruginosa strain. The mutation rate was 47. The mutation type was 26 amino acid (Leu Val). 84 strain) nfxB gene mutation, the gene mutation rate was 28%, and the mutation type was Arg Leu). Conclusion the drug resistance of Pseudomonas aeruginosa to common antimicrobial agents is different in thoracic surgery patients, and the mutation of drug resistance gene of Pseudomonas aeruginosa is related to the drug resistance of bacteria.
【作者单位】：南阳市中心医院胸外科;河南省南阳市中心医院特需病房一病区;北京大学附属深圳医院胸外科;
【分类号】：R446.5

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