肺部感染患者多重耐药铜绿假单胞菌的耐药谱与特征

周俊立; 张文萃; 王莹莹; 郑惠结; 刘宁; 李荧; 何穗平; 贡梓军; 姚振江

doi:10.16462/j.cnki.zhjbkz.2020.09.011

肺部感染患者多重耐药铜绿假单胞菌的耐药谱与特征

doi: 10.16462/j.cnki.zhjbkz.2020.09.011

510310 广州, 广东药科大学公共卫生学院流行病与卫生统计学系

基金项目:

广东省科技厅计划项目 2008B030301034

详细信息

通讯作者:
姚振江, E-mail:zhjyao2001@yahoo.com

中图分类号: R446.5
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出版历程
- 收稿日期: 2019-12-17
- 修回日期: 2020-04-08
- 刊出日期: 2020-09-10

Drug resistance spectrum and characteristics of multi-drug resistant Pseudomonas aeruginosa in patients with pulmonary infection

Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China

Funds:

Guangdong Science and Technology Planning Projet 2008B030301034

More Information

Corresponding author: YAO Zhen-jiang ,E-mail:zhjyao2001@yahoo.com

摘要

摘要: 目的了解广州市肺部感染患者分离的多重耐药铜绿假单胞菌（multi-drug resistant Pseudomonas aeruginosa，MDRPA）的耐药谱、产酶情况、耐药基因及其整合子基因的分布情况。方法对2008年-2012年在广州市某5所医院肺部感染患者中收集分离的MDRPA菌株，进行药敏试验和基因检测。结果共收集248株铜绿假单胞菌，分离MDRPA145株，多重耐药率为58.47%；对所测抗生素的耐药率均超过50.00%。MDRPA菌株产超广谱β-内酰胺酶（extended spectrum β-lactamases，ESBLs）、金属β内酰胺酶（metallo β lactamases，MBL）、C类头孢菌素酶（class C cephalosporinases，AmpC）的检出率分别为17.93%、21.38%和17.24%；ESBLs编码基因TEM、PER、OXA-10的检出率分别为54.48%、25.52%和33.79%，MBL编码基因IMP、VIM检出率分别为21.38%、9.66%，OprD2基因缺失率为32.41%，氨基糖苷类耐药基因ant（3″）-Ⅰ和aac（6'）-Ⅱ检出率分别为43.45%和40.69%，Ⅰ类整合子基因检出率为62.07%。结论广州市肺部感染患者铜绿假单胞菌的多重耐药现象严重，同时β-内酰胺酶及其编码基因、Ⅰ类整合子基因和多种耐药基因广泛存在于MDRPA中，应引起高度重视。
- 铜绿假单胞菌 /
- 肺部感染 /
- 多重耐药 /
- β-内酰胺酶 /
- 基因
Abstract: Objective To analyze drug resistance spectrum, production of beta-lactamases, distribution of drug-resistant genes and integrons genes in multi-drug resistant Pseudomonas aeruginosa (MDRPA) isolated from patients with pulmonary infection in Guangzhou City. Methods Antimicrobial susceptibility testing and genetic testing were performed for MDRPA isolates, which were collected from patients with pulmonary infection in five hospitals in Guangzhou from 2008 to 2012. Results Of the 248 Pseudomonas aeruginosa isolates, the prevalance of MDRPA was 58.47%. The resistance rates to antibiotics used were over 50.00%. Among 145 MDRPA strains, the detection rate of production of extended spectrum β-lactamases (ESBLs), metallo β lactamases (MBL) and class C cephalosporinases (AmpC) was 17.93%, 21.38%, 17.24%, respectively. The detection rate of encoding genes was TEM (54.48%), PER (25.52%), OXA-10 (33.79%), IMP (21.38%) and VIM (9.66%), respectively, and the lacking rate of OprD2 gene was 32.41%. The detection rate of aminoglycoside modifying enzyme genes ant(3″)-Ⅰ and aac(6')-Ⅱ was 43.45% and 40.69%, respectively, and class Ⅰ integron gene was 62.07%. Conclusion The multi-drug resistance situation of Pseudomonas aeruginosa in patients with pulmonary infection in Guangzhou is serious. Meanwhile, β-lactamase and its coding genes, class Ⅰ integron genes and a variety of drug resistance genes are widely found in MDRPA, which should be paid more attention to.
- Pseudomonas aeruginosa /
- Pulmonary infection /
- Multi-drug resistance /
- β-lactamase /
- Gene

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图 1 MDRPA在抗生素种类耐药数量的分布

Figure 1. Distribution of numbers of drug resistance in MDRPA

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表 1 2008—2012年MDRPA对13种抗生素的耐药情况[n(%)]

Table 1. Antimicrobial resistance rates of MDRPA to 13 kinds of antibiotics from 2008 to 2012 [n(%)]

抗生素	2008年(n=16)	2009年(n=35)	2010年(n=21)	2011年(n=34)	2012年(n=39)	合计(n=145)
头孢菌素类
头孢他啶^a	12(75.00)	26(74.29)	16(76.19)	21(61.76)	34(87.18)	109(75.17)
头孢吡肟^a	12(75.00)	19(54.29)	16(76.19)	28(82.35)	34(87.18)	109(75.17)
单环内酰胺类
氨曲南	13(81.25)	33(94.29)	19(90.48)	28(82.35)	28(71.79)	121(83.45)
青霉素类
哌拉西林^a	10(62.50)	22(62.86)	16(76.19)	28(82.35)	31(79.49)	107(73.79)
替卡西林^a	13(81.25)	26(74.29)	16(76.19)	25(73.53)	36(92.31)	116(80.00)
β-内酰胺酶抑制复合剂
哌拉西林/他唑巴坦^a	8(50.00)	18(51.43)	14(66.67)	26(76.47)	25(64.10)	91(62.76)
碳青霉烯类
美洛培南^a	6(37.50)	16(45.71)	15(71.43)	21(61.76)	18(46.15)	76(52.41)
亚胺培南	7(43.75)	20(57.14)	15(71.43)	27(79.41)	15(38.46)	84(57.93)
喹诺酮类
环丙沙星	14(87.50)	23(65.71)	19(90.48)	23(67.65)	23(58.97)	102(70.34)
左氧氟沙星	14(87.50)	22(62.86)	20(95.24)	24(70.59)	19(48.72)	99(68.28)
氨基糖苷类
庆大霉素^a	9(56.25)	18(51.43)	14(66.67)	25(73.53)	32(82.05)	98(67.59)
妥布霉素^a	10(62.50)	17(48.57)	12(57.14)	23(67.65)	28(71.79)	90(62.07)
阿米卡星^a	7(43.75)	15(42.86)	10(47.62)	20(58.82)	23(58.97)	75(51.72)
注：^a表示使用趋势性χ²检验，P < 0.05。

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表 2 MDRPA和NMDRPA的β-内酰胺酶检测情况[n(%)]

Table 2. Isolates rate of beta-lactamases in MDRPA and NMDRPA[n(%)]

酶	MDRPA (n=145)	NMDRPA (n=103)	合计(n=248)	χ²值	P值
ESBLs	26(17.93)	6(5.83)	32(12.90)	7.85	0.005
MBL	31(21.38)	2(1.94)	33(13.31)	19.72	< 0.001
AmpC	25(17.24)	11(10.68)	36(14.52)	2.09	0.148

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表 3 MDRPA和NMDRPA的基因检测情况[n(%)]

Table 3. Detection rate of genes in MDRPA and NMDRPA[n(%)]

基因	MDRPA (n=145)	NMDRPA (n=103)	合计(n=248)	χ²值	P值
β-内酰胺酶相关基因
TEM	79(54.48)	37(35.92)	116(46.77)	8.33	0.004
PER	37(25.52)	23(22.33)	60(24.19)	0.33	0.564
OXA-10	49(33.79)	12(11.65)	61(24.60)	15.92	< 0.001
IMP	31(21.38)	11(10.68)	42(16.94)	4.90	0.027
VIM	14(9.66)	0 (0.00)	14(5.65)	10.54	0.001
外膜孔蛋白基因
OprD2	98(67.59)	95(92.23)	193(77.82)	21.20	< 0.001
氨基糖苷类耐药基因
ant(3″)-Ⅰ	63(43.45)	23(22.33)	86(34.68)	11.86	0.001
aac(6′)-Ⅱ	59(40.69)	9(8.74)	68(27.42)	30.89	< 0.001
整合子基因
Ⅰ类	90(62.07)	40(38.83)	130(52.42)	13.03	< 0.001

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