重庆某三甲医院2014-2016年铜绿假单胞菌耐药表型及金属酶、外膜孔蛋白耐药基因型分析

发布时间：2018-07-29 13:14

【摘要】：目的检测亚胺培南耐药铜绿假单胞菌金属酶基因分布和外膜孔蛋白OprD2基因缺失情况,了解铜绿假单胞菌的耐药状况。方法收集第三军医大学大坪医院野战外科研究所2014-2016年临床分离的非重复铜绿假单胞菌1 887株,VITEK-MS质谱仪进行菌株鉴定,最小抑菌浓度(minimal inhibitory concentration,MIC)法测定其对10种常用抗菌药物的敏感性,利用WHONET5.6软件对药敏资料进行统计分析,同时采用亚胺培南-EDTA纸片法筛选金属酶表型阳性的菌株,用聚合酶链反应(polymerase chain reaction,PCR)测铜绿假单胞菌金属β-内酰酶(metallo-β-lactamase,MBL)相关基因(IMP、VIM、SPM、GIM、SIM、NDM)和外膜孔蛋白OprD2基因的情况。结果 3年中铜绿假单胞菌每年的分离数量分别为756株(9.4%)、579株(9.5%)和552株(10.7%),主要来自ICU病房和呼吸内科病房,标本类型以痰液为主;2014-2016年分离出的铜绿假单胞菌对妥布霉素、庆大霉素的耐药率逐年下降,其耐药率分别从2014年的11.3%、13.2%下降至2016年的7.8%、9.0%,对左旋氧氟沙星、哌拉西林/他唑巴坦的耐药率呈上升趋势,其耐药率从2014年的10.7%、9.2%上升至2016年的23.5%、11.6%。从基因型分布情况来看,269株亚胺培南耐药铜绿假单胞菌中MBL基因阳性51株(18.9%),外膜孔蛋白OprD2缺失158株(58.7%);51株产酶菌株中VIM型阳性29株,SPM型阳性22株,未检测出其他基因型。结论铜绿假单胞菌对亚胺培南的耐药率较高;产MBL和外膜孔蛋白OprD2基因缺失是引起铜绿假单胞菌对亚胺培南耐药的主要原因。
[Abstract]:Objective to detect the distribution of imipenem resistant Pseudomonas aeruginosa metalloenzyme gene and the deletion of outer membrane pore protein (OprD2) gene, and to understand the drug resistance of Pseudomonas aeruginosa. Methods A total of 1 887 strains of Pseudomonas aeruginosa isolated from the Institute of Field surgery, Daping Hospital, third military Medical University, were collected from 2014-2016 to identify the strains by VITEK-MS. The minimal inhibitory concentration (minimal inhibitory) assay was used to determine the sensitivity of 10 commonly used antimicrobial agents. The susceptibility data were statistically analyzed by WHONET5.6 software. Meanwhile, imipenem-EDTA disk method was used to screen the strains with positive phenotype of metallozyme. The metallo- 尾 -lactamase related gene (IMP- 尾 -lactamase) associated gene (IMP-VIM-SIM-SIM-NDM) and the outer membrane pore protein (OprD2) gene of Pseudomonas aeruginosa were detected by polymerase chain reaction (polymerase chain) reaction- PCR. Results the number of Pseudomonas aeruginosa isolates were 756 (9.4%) and 552 (10.7%) per year, mainly from ICU ward and respiratory ward. The main types of samples were sputum and Pseudomonas aeruginosa ptobramycin from 2014-2016. The resistance rate of gentamicin decreased from 11.32% in 2014 to 7.8% in 2016. The resistance rate of gentamicin to levofloxacin, piperacillin / tazobactam increased from 10.7% in 2014 to 23.5% in 2016. According to the distribution of genotypes, 51 (18.9%) strains of imipenem resistant Pseudomonas aeruginosa were found to be positive for MBL gene, and 22 (58.7%) strains were positive for VIM type among 51 strains with OprD2 deletion of outer membrane pore protein. No other genotypes were detected. Conclusion the resistance rate of Pseudomonas aeruginosa to imipenem is high, and the deletion of MBL and OprD2 gene is the main cause of imipenem resistance of Pseudomonas aeruginosa.
【作者单位】：第三军医大学大坪医院野战外科研究所检验科;重庆医科大学附属儿童医院检验科;
【基金】：全军医学科研“十二五”计划面上项目(CWS13J039) 国家自然科学基金重点项目(81430053)~~
【分类号】：R446.5

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