攀枝花市中心医院铜绿假单胞菌的耐药性及耐药基因检测

目的 分析攀枝花市中心医院多重耐药铜绿假单胞菌（MDR-PA）的耐药性及其相关的耐药基因。 方法 回顾性分析2017年1月至2019年12月医院临床检出的非重复铜绿假单胞菌（PA）995株，采用微量肉汤稀释法进行药敏试验，PCR法检测35株MDR-PA的耐药基因oprD2、oprM、mexR、mexC、VIM、IMP、DHA并测序。采用WHONET 5.6软件统计分析耐药数据，Fisher精确检验分析亚胺培南耐药株与敏感株基因差异。 结果 检出MDR-PA 114株，占比11.46%，科室来源主要为神经科和ICU病房，标本主要来自痰和分泌物，对氨基糖苷类抗生素耐药率最低，介于2.63%～6.14%；对左旋氧氟沙星、环丙沙星、头孢哌酮/舒巴坦、头孢吡肟、亚胺培南的耐药率依次为7.02%、10.53%、25.44%、35.96%、44.74%；对哌拉西林/他唑巴坦、氨曲南、头孢他啶的耐药率较高，分别为53.51%、60.53%、100.00%。oprM、mexR、mexC、oprD2基因检出率分别为14.29％、91.43％、97.14％、100.00％，余未检出。随机抽取35株MDR-PA中有13株是亚胺培南耐药株，22株为亚胺培南敏感株，比较亚胺培南耐药株和敏感株，oprM（ P =0.426）、mexR（ P =0.541）、mexC（ P =0.371）基因检测差异无统计学意义。 结论 攀枝花市中心医院MDR-PA耐药率较高，耐药基因以mexC、mexR为主，但MDR-PA对亚胺培南的耐药与此两种基因无明显关系，耐药性的产生与oprD2基因缺失关系不大。

Drug resistance of Pseudomonas aeruginosa and detection of resistance genes in central hospital,Panzhihua

To analyze the drug resistant of multidrug-resistant Pseudomonas aeruginosa(MDR-PA) and its related resistant genes in Central Hospital of Panzhihua. Methods A total of 995 non-repetitive strains of P.aeruginosa(PA) isolated from hospital from Jan. 2017 to Dec. 2019 were retrospectively analyzed. The drug sensitivity test was carried out by dilution method of microbroth. The drug-resistant genes of 35 strains of MDR-PA were detected and sequenced by PCR, including oprD2, oprM, mexR, mexC, VIM, IMP and DHA. WHONET5.6 software was used for statistical analysis of drug resistance data, and Fisher?s accurate test was used to analyze the genetic differences between imipenem resistant and sensitive strains. Results A total of 114 strains of MDR-PA were detected, accounting for 11.46% of the total. The main sources of departments were neurology department and ICU ward, and the specimens were mainly from sputum and secretions. The resistant rates of MDR-PA to aminoglycoside antibiotics was the lowest, ranging from 2.63% to 6.14%. The resistant rates to levofloxacin, ciprofloxacin, cefoperazone/sulbactam, cefepime, imipenem were 7.02%, 10.53%, 25.44%, 35.96% and 44.74% respectively, and to piperacillin/tazobactam, aztreonam and ceftazidime were higher, which were 53.51%, 60.53% and 100.00%. The detection rates of oprM, mexR, mexC, and oprD2 genes were 14.29%, 91.43%, 97.14%, and 100.00%, respectively, the rest were not detected. Among the 35 strains of MDR-PA randomly selected, 13 were imipenem resistant strains and 22 were imipenem sensitive strains, there were no statistically significant differences in oprM(P=0.426), mexR(P=0.541) and mexC(P=0.371) genes between the imipenem resistant and sensitive strains. Conclusion The drug resistant rate of MDR-PA in Central Hospital of Panzhihua is relatively high, and the drug-resistant genes are mainly mexC and mexR, but MDR-PA resistance to imipenem had no significant relationship with these two genes, The occurrence of drug resistance is not closely related to the deletion of oprD2 gene.