摘要
目的了解耐碳青霉烯类铜绿假单胞菌(CRPA)临床分离菌株的流行特征,检测、分析耐消毒剂基因携带情况及菌株同源性。方法回顾性分析该院2020—2022年临床分离得到的252株CRPA的临床分布特点、耐药趋势。并随机选取其中30株菌株,采用聚合酶链反应检测耐消毒剂基因qacEΔ1-sul1及aceⅠ的表达情况;采用肠杆菌科基因间重复序列-聚合酶链反应检测菌株同源性。结果CRPA的标本来源主要为痰液(63.49%)、肺泡灌洗液(17.06%);来自综合重症监护病房(ICU)和其他ICU占比为40.87%,来自非ICU的占比为59.13%,非ICU病区主要分布在康复医学科(14.68%)和呼吸科(12.70%)。除头孢吡肟、头孢他啶/阿维巴坦、阿米卡星、庆大霉素、妥布霉素、多黏菌素外,CRPA对其他临床常用抗菌药物的耐药率均在30.00%以上。CRPA在ICU及非ICU病区的耐药率比较,差异无统计学意义(P>0.05)。30株临床分离的CRPA qacEΔ1-sul1和aceⅠ基因检出率分别为16.67%、26.67%。同源性分析结果显示A型和B型为主要流行株。结论CRPA对常用抗菌药物普遍耐药,应加强对CRPA菌株的耐药性监测,根据药敏试验结果合理选择抗菌药物,减少耐药株的产生。CRPA中qacEΔ1-sul1和aceⅠ两种耐消毒剂基因均有检出,但检出率均较低,实际工作中应加强对各病区的消毒效果监测。CRPA中存在A、B两种优势型别的克隆流行,应作为铜绿假单胞菌院内感染防控的重点。
Objective To investigate the drug resistance characteristics of carbapenem-resistant Pseudomonas aeruginosa(CRPA)isolates,and to detect the antiseptics resistance genes and homology of CRPA.Methods The clinical distribution characteristics and drug resistance trend of 252 CRPA isolates from the Second Affiliated Hospital of Guangxi Medical University from 2020 to 2022 were analyzed retrospectively.The polymerase chain reaction method was used to amplify antiseptics genes.The homology of the strains was analyzed by enterobacterial repetitive intergenic consensus-polymerase chain reaction.Results The main sources of CRPA were sputum(63.49%)and alveolar lavage fluid(17.06%).The proportion of patients from the comprehensive intensive care unit(ICU)and other ICU was 40.87%,and the proportion from the non-ICU was 59.13%,and the non-ICU was mainly distributed in the rehabilitation medicine department(14.68%)and the respiratory department(12.70%).In addition to cefepime,ceftazidime/avibactam,amicacin,gentamicin,tobramycin,the drug resistance rate of CRPA to other commonly used clinical antibiotics was more than 30.00%.There was no significant difference in drug resistance rate of CRPA in ICU and non-ICU(P>0.05).The positive rates of qacEΔ1-sul1 and ace Ⅰ genes in 30 CRPA isolates were 16.67% and 26.67% respectively.Homology analysis showed that type A and type B were the main epidemic stains.Conclusion CRPA is generally resistant to common antibiotics.It is necessary to strengthen the drug resistance monitoring of CRPA strains and rationally select antibiotics according to the drug sensitivity results to reduce the generation of drug-resistant strains.qacEΔ1-sul1 and aceⅠare detected in CRPA,but the positi ve rates are low.It is suggested to strengthen the monitoring of disinfection effect in each medical area.The homology analysis founds that typeA and typeB are main epidemic clonal strains,and should be the key objects of hospital infection control for PA.
作者
梁琼
李素艳
蒙华莹
唐娟
覃卫娟
李春燕
LIANG Qiong;LI Suyan;MENG Huaying;TANG Juan;QIN Weijuan;LI Chunyan(Department of Nosocomial Infection,the Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530000,China;Medical Clinical Laboratory,the Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530000,China;Center for Medical Genetics and Genomics,the Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530000,China)
出处
《检验医学与临床》
2024年第4期444-449,共6页
Laboratory Medicine and Clinic
基金
广西壮族自治区卫生健康委员会自筹课题(Z20201496)。
关键词
耐碳青霉烯类铜绿假单胞菌
耐消毒剂基因
同源性分析
耐药性
流行特征
carbapenem-resistant Pseudomonas aeruginosa
antiseptics resistance gene
homology analysis
drug resistance
epidemic characteristc
