西安地区耐亚胺培南铜绿假单胞菌耐药现状及碳青霉烯酶基因研究

摘要

Objective To investigate the drug resistance status quo of imipenem-resistant Pseudomonas aeruginosa and carbap-enemase gene carrying in Xi′an area for guiding the clinical rational use of antibacterial drugs.Methods 151 strains of imipenem-re-sistant Pseudomonas aeruginosa isolated from clinical samples in 4 hospitals from August 2012 to July 2013 were continuously col-lected.Then the drug resistance characteristics of imipenem-resistant Pseudomonas aeruginosa were investigated by the antimicrobi-al drug sensitivity test.The PCR technique was adopted to detect the carrying situation of carbapenemase drug-resistance genes in imipenem-resistant Pseudomonas aeruginosa.Results Totally isolated 151 strains of imipenem-resistant Pseudomonas aeruginosa were mainly distributed in the neurosurgery ICU (37.1%),neurology ICU (27.1%)and the burn department (19.9%);the detec-ted strains were sensitive to polymyxin B and resistant to other 9 kinds of antibacterial drugs in different degrees;94 strains carried VIM gene,32 strains carried IMP gene,5 strains carried SPM gene and 3 strains carried SIM gene.Conclusion The multidrug re-sistance and pan-drug resistance phenomenon of imipenem-resistant Pseudomonas aeruginosa is serious,its cause might be related with the carbapenemases-producing drug resistant gene expression,the drug resistance genes are dominated by VIM and IMP.Clinic should strengthen the bacterial drug resistance monitoring and use antibacterial drugs rationally and effectively for preventing the spreading of imipenem-resistant Pseudomonas aeruginosa.%目的：调查西安地区耐亚胺培南铜绿假单胞菌的耐药现状及碳青霉烯酶耐药基因携带情况，指导临床合理使用抗菌药。方法连续收集2012年8月至2013年7月西安地区四所医院临床标本中分离的耐亚胺培南铜绿假单胞菌共151株，通过药物敏感试验了解耐亚胺培南铜绿假单胞菌耐药特征，并采用聚合酶链反应技术（PCR）检测碳青霉烯酶耐药基因在耐亚胺培南铜绿假单胞菌中的携带情况。结果151株耐亚胺培南铜绿假单胞菌主要分布在神经外科 ICU （37．1％）、神经内科 ICU （27．1％）及烧伤科（19．9％）；所检菌株对多黏菌素 B 敏感，对其余9种抗菌药物均不同程度耐药；94株携带 VIM 基因，32株携带IMP 基因，5株携带 SPM 基因，3株携带 SIM 基因。结论耐亚胺培南铜绿假单胞菌多药耐药及泛耐药现象严重，其原因可能与产碳青霉烯酶耐药基因表达有关，耐药基因以 VIM、IMP 为主，临床应加强细菌耐药性监测，合理有效使用抗菌药物，防止耐亚胺培南铜绿假单胞菌的蔓延。