耐碳青霉烯类铜绿假单胞菌的耐药性分析

目的了解医院耐碳青霉烯类铜绿假单胞菌耐药性,指导临床合理使用抗菌药物。方法统计分析2010年1月-2011年1月30例耐碳青霉烯类铜绿假单胞感染患者感染部位、科室分布及耐药性;细菌鉴定采用VITEK-32细菌鉴定系统,药敏试验采用纸片扩散(K-B)法,采用WHO细菌耐药监测网提供的WHONET5.4软件进行统计分析。结果全年共分离出铜绿假单胞菌1 144株,其中耐碳青霉烯类铜绿假单胞菌30株,检出率为2.6%;30株耐碳青霉烯类铜绿假单胞菌以痰液检出率最高,占66.6%;科室分布以重症监护病房为主,其次是神经内科,分别占50.0%、26.7%;耐碳青霉烯类铜绿假单胞菌仅对多黏菌素B的耐药率为0,对阿米卡星耐药率为17.7%,对其他抗菌药物耐药率均>80.0%。结论耐碳青霉烯类铜绿假单胞菌临床分布比较集中,对常用抗菌药物呈高度耐药,给临床治疗带来严重挑战,提示临床加强抗菌药物的管理和对耐碳青霉烯类铜绿假单胞菌感染病例的实时监控,防止和减少此类耐药菌在医院内传播。     

耐碳青霉烯铜绿假单胞菌耐药性的基因学研究进展

碳青霉烯类抗生素是治疗铜绿假单胞菌感染的有效药物,但随着此类抗生素的广泛应用,铜绿假单胞菌对碳青霉烯类抗生素的耐药率呈上升趋势。本文从药物的主动转运系统、抗菌药物渗透障碍、产生药物灭活酶及形成生物被膜这4个方面对耐碳青霉烯铜绿假单胞菌耐药性的基因学研究进行综述,为临床合理应用抗生素和进行感染防控提供理论依据。     

耐碳青霉烯类铜绿假单胞菌的药物敏感性与耐药机制研究

目的 研究耐碳青霉烯类铜绿假单胞菌的药物敏感性及铜绿假单胞菌对碳青霉烯类抗菌药物的耐药机制,为指导临床用药提供试验依据.方法 应用琼脂稀释法检测耐碳青霉烯类铜绿假单胞菌的药物敏感性,采用重复序列聚合酶链反应进行菌株同源性分析;应用纸片增敏协同试验筛选产金属酶的菌株,设计外排泵抑制试验对耐药菌株的外排泵进行检测.结果 耐碳青霉烯类铜绿假单胞菌的耐药率以环丙沙星、多黏菌素E较低;同源性研究结果显示,共有8个型别;75株碳青霉烯类耐药株中,13株为金属酶阳性;外排泵抑制剂可以使34株美罗培南耐药株的MIC值较单药时降低≥4倍.结论 该院分离的耐碳青霉烯类铜绿假单胞菌以A、B型为主;严重感染患者可以考虑使用环丙沙星等抗菌药物;产金属酶和外排泵等耐药外排系统可能是导致铜绿假单胞菌对碳青霉烯类耐药的主要原因.     

耐碳青霉烯类铜绿假单胞菌产金属β-内酰胺酶的检测及耐药性分析

目的了解医院耐碳青霉烯类铜绿假单胞菌产金属β-内酰胺酶(MBL)情况及其对临床常用抗菌药物的耐药性,为临床抗感染治疗提供依据。方法采用E-test检测铜绿假单胞菌是否产生MBL,用BD Phoenix 100全自动微生物测定铜绿假单胞菌对常用15种抗菌药物的耐药性。结果在分离的189株铜绿假单胞菌中耐碳青霉烯类的有54株(28.6%),其中产MBL的有13株(24.1%);耐碳青霉烯类铜绿假单胞菌与碳青霉烯类敏感铜绿假单胞菌对大多数常用抗菌药物的敏感性差异有统计学意义。结论医院耐碳青霉烯类的铜绿假单胞菌检出率较高,多药耐药现象较严重,产MBL是铜绿假单胞菌对碳青霉烯类药物耐药的主要原因之一,临床医师应参考微生物实验室的药敏结果,合理选用抗菌药物。     

人工气道患者耐碳青霉烯类抗菌药物铜绿假单胞菌肺部感染危险因素

目的分析重症医学科建立人工气道机械通气患者碳青霉烯类抗菌药物耐药铜绿假单胞菌(Carbapenem-resistant Pseudomonas aeruginosa,CRPA)肺部感染的危险因素及耐药性。方法选择2016年1月-2019年12月首都医科大学附属北京世纪坛医院重症医学科铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染患者388例,其中CRPA肺部感染患者251例为研究组,碳青霉烯类抗菌药物敏感铜绿假单胞菌(Carbapenem-sensitive Pseudomonas aeruginosa,CSPA)肺部感染患者137例为对照组,比较两组患者年龄、合并基础疾病、抗菌药物使用及炎症因子指标等临床资料,分析人工气道机械通气患者CRPA肺部感染的危险因素,分析两组患者对常用抗菌药物的耐药性,并对PA常见耐药基因进行检测。结果两组患者年龄、APACHEⅡ评分、入院前卧床时间、炎症因子水平、合并慢性阻塞性肺病(COPD)、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物、低蛋白血症比较差异有统计学意义(P0.05);其中合并COPD、机械通气时间10 d、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物是人工气道患者CRPA感染的独立危险因素(P0.05);研究组对常用抗菌药物的耐药率均高于对照组;研究组除对阿米卡星耐药率为16.33%,头孢他啶25.50%外,其余耐药率均高于55.00%。碳青霉烯类抗菌药物耐药铜绿假单胞菌含有IMP、VIM、OXA-23、OXA-51等多种耐药基因。结论 CRPA肺部感染与合并COPD、铜绿假单胞菌检出前使用过碳青霉烯类抗菌药物、机械通气等多种因素相关,CRPA含有多种碳青霉烯类抗菌药物耐药基因,耐药率较高,预后差。     

呼吸与危重症医学病房分离的碳青霉烯耐药铜绿假单胞菌的分子流行病学

目的了解呼吸与危重症医学病房分离的碳青霉烯耐药铜绿假单胞菌的分子流行病学特点。方法收集陆军军医大学大坪医院2018年1-12月呼吸与危重症医学病房分离的20株碳青霉烯耐药铜绿假单胞菌,检测其对常用抗菌药物的敏感性,通过聚合酶链反应(Polymerase chain reaction,PCR)扩增主要的碳青霉烯酶基因(bla_(KPC-2)、bla_(IMP)、bla_(VIM)、bla_(SPM)、bla_(NDM-1)和bla_(OXA-48)),利用脉冲场凝胶电泳(Pulsed field gel electrophoresis,PFGE)对20株碳青霉烯耐药铜绿假单胞菌进行同源性分析。结果呼吸与危重症医学病房分离的20株碳青霉烯耐药铜绿假单胞菌对10种常用抗菌药物的耐药率均40.0%; 20株碳青霉烯耐药铜绿假单胞菌中有6株携带bla_(VIM)基因,6株携带bla_(SPM)基因,2株携带bla_(KPC)基因,剩余6株未携带耐药基因; PFGE结果显示,20株碳青霉烯耐药铜绿假单胞菌可分为A～F共6个谱型,其中E型占35%,C型占20%。结论医院呼吸与危重症医学病房分离的碳青霉烯耐药铜绿假单胞菌主要以产SPM型和VIM型碳青霉烯酶为主,存在部分耐碳青霉烯铜绿假单胞菌的克隆传播,临床上应严格做好耐药菌的防控工作,避免耐碳青霉烯铜绿假单胞菌在呼吸与危重症医学病房感染暴发流行。     

2014—2021年山东省某医院血流感染铜绿假单胞菌的耐药及分子流行病学特征

目的探讨引起血流感染铜绿假单胞菌(Pseudomonas aeruginosa, P. aeruginosa)的耐药性、毒力基因携带情况以及多位点序列分型(MLST)的型别。方法回顾性收集2014年11月至2021年12月山东第一医科大学第一附属医院引起血流感染的铜绿假单胞菌94株。使用基质辅助激光解析/电离飞行时间质谱仪对铜绿假单胞菌进行菌种鉴定, 使用Vitek 2 Compact 全自动细菌药敏分析系统对铜绿假单胞菌进行抗菌药物敏感性实验。应用聚合酶链式反应(PCR)方法对18种常见毒力基因的携带情况进行检测。应用MLST对分离菌株进行分型。采用卡方检验对碳青霉烯类抗生素耐药的铜绿假单胞菌(carbapenem resistantpseudomonas aeruginosa, CRPA)和碳青霉烯类抗生素敏感的铜绿假单胞菌(carbapenem susceptiblepseudomonas aeruginosa, CSPA)菌株的耐药及毒力基因的携带情况进行比较。结果在94株铜绿假单胞菌中, 有19株(20.2%)为多重耐药(MDR)菌株, 其中有17株为碳青霉烯类抗菌药物耐药株...     

铜绿假单胞菌耐药性的变迁

目的分析临床分离的铜绿假单胞菌耐药性变迁,为铜绿假单胞菌感染的临床治疗提供依据。方法对2009-2012年共分离出412株铜绿假单胞菌采用纸片法测定对抗菌药物的敏感性,采用WHONET5.6软件统计分析。结果共分离出铜绿假单胞菌412株,标本主要为痰液和支气管灌洗液,占60.00%;铜绿假单胞菌感染主要发生在ICU、消化内科和神经科分离率明显增高;铜绿假单胞菌2009-2010年对多种抗菌药物的耐药性均呈上升趋势,对多黏菌素B耐药率为0,对阿米卡星耐药率约7.00%,其次头孢哌酮/舒巴坦4年中耐药率均<20.00%,对其他抗菌药物包括碳青霉烯类抗菌药物亚胺培南、美罗培南耐药率均>30.00%,4年头孢噻肟耐药率达到100.00%;经抗菌药物治理,2011-2012年耐药性均有所下降。结论铜绿假单胞菌是医院感染的重要致病菌,应加强对铜绿假单胞菌引起感染的管理,规范抗菌药物使用,减少耐药性发生。     

耐碳青霉烯类铜绿假单胞菌耐药基因的研究

目的探讨瑞安市人民医院临床分离的耐碳青霉烯类铜绿假单胞菌的耐药特征与基因型分布,为临床合理使用抗生素提供参考依据。方法收集本院2012年1月-2017年12月经VITEK 2全自动微生物分析仪鉴定的铜绿假单胞菌10 288株;分离4 072株耐碳青霉烯类铜绿假单胞菌并进行耐药特征分析;筛选耐碳青霉烯菌210株,采用PCR法进一步分析其基因型:检测外膜通透蛋白Opr-D2基因及5种主要金属β-内酰胺酶基因(IMP-1、IMP-2、VIM-1、VIM-2、SPM)。结果 10 288株铜绿假单胞菌以痰液标本为主,主要分布于重症监护室;4 072株耐碳青霉烯类铜绿假单胞菌对替卡西林/克拉维酸、美罗培南的耐药率相对较高;210株耐碳青霉烯类铜绿假单胞菌中携带有SPM基因的铜绿假单胞菌18株,占8.6%,携带Opr-D2基因54株,外膜蛋白缺失率为74.3%,其余基因型均阴性。结论本院耐碳青霉烯类铜绿假单胞菌的耐药机制主要为外膜蛋白Opr-D2缺失和产SPM型金属酶,临床应结合药敏谱,合理使用抗生素。     

铜绿假单胞菌对碳青霉烯类抗生素耐药率探究

目的探讨分析铜绿假单胞菌对碳青霉烯类抗生素耐药率。方法收集我院2006年1月~2013年12月临床分离的430株铜绿假单胞菌,使用碳青霉烯类抗生素对其进行药敏实验,统计分析铜绿假单胞菌对该类抗生素的耐药性。结果铜绿假单胞菌分离率呈逐年增长的趋势,对亚胺培南的耐药率由2006年的2.54%逐渐上升到2013年的41.52%,呈逐年增长的趋势,差异均具有统计学意义(P0.05)。结论铜绿假单胞菌对碳青霉烯类抗生素耐药率呈逐年上升的趋势,临床用药时要适当控制碳青霉烯类抗生素的使用,以延缓及控制耐药株的产生。     

全国细菌耐药监测网2014—2019年胆汁细菌耐药监测报告

目的了解全国胆道感染细菌分布和细菌耐药情况,为临床抗菌药物选择提供参考。方法按照全国细菌耐药监测网(CARSS)技术方案,利用WHONET 5.6软件对2014—2019年CARSS成员单位上报胆汁标本分离的细菌及药敏结果数据进行分析,同一患者相同细菌仅纳入第一株菌。结果共分析268016株细菌,居前8位的依次为大肠埃希菌(30.9%)、肺炎克雷伯菌(12.7%)、屎肠球菌(10.1%)、粪肠球菌(8.6%)、铜绿假单胞菌(4.9%)、阴沟肠杆菌(4.5%)、鲍曼不动杆菌(2.2%)、弗劳地柠檬酸杆菌(1.8%)。药敏结果显示,6年间,大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素的耐药率分别为33.7%~65.6%、23.6%~43.5%,对喹诺酮类抗生素耐药率分别为48.9%~56.6%、22.0%~28.5%,对碳青霉烯类抗生素耐药率分别为1.1%~3.7%、3.5%~7.6%;铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率分别为13.4%~19.0%、29.3%~42.7%,对碳青霉烯类抗生素耐药率分别为18.0%~28.0%、44.5%~59.9%;屎肠球菌和粪肠球菌对万古霉素耐药率分别为0.6%~1.7%、0.3%~0.7%。结论中国胆道感染病原菌以革兰阴性菌为主,主要为肠杆菌目细菌;常见病原菌对多种抗菌药物耐药明显,临床抗菌药物选择应参考耐药监测结果。     

Vegetables as a source of infection with Pseudomonas aeruginosa in a University and Oncology Hospital of Rio de Janeiro

Samples of fresh vegetables fed to patients in an Oncology and a University Hospital were examined for frequency of recovery and counts of Pseudomonas aeruginosa. Thirty-eight isolates from vegetables as well as 98 clinical isolates recovered during the same period of vegetable collection were serotyped and assayed for pyocin production in order to evaluate the role of vegetables as a source of microorganisms. Pseudomonas aeruginosa was recovered from 19·0% of the vegetable samples. Although 1% hypochlorite solution was used as a sanitizer, 50% of the positive samples were found to harbour more than 100 colony-forming units (ctu) g⁻¹. Lettuce, chicory and watercress yielded the highest frequencies of isolation (P < 0·05). The pyocin typing and serotyping of clinical strains revealed some types identical to those recovered from vegetables. Among those found in the University Hospital, serotype O4 and pyocin type PT10/b were detected in vegetables and in clinical specimens whereas types O1-PT22/e, O2a-PT10/a, O2a-PT10/b, O4-PT10/a, O11-PT10/a and O11-PT10/b were common in both groups of strains isolated in the Oncology Hospital. Our results strongly suggest that vegetables represent a source of endemic infection with P. aeruginosa for hospitalized patients.     

Development of resistance to chlorhexidine diacetate in Pseudomonas aeruginosa and the effect of a 'residual' concentration

Stable resistance in Pseudomonas aeruginosa NCIMB 10421 was obtained by step-wise exposure to gradually increasing concentrations of chlorhexidine diacetate (CHX). Repeated exposure to a proposed 'residual' (sub-MIC) concentration of CHX also created stable resistance. Resistance was also developed by a single exposure to the 'residual' concentration of CHX, but this was unstable. Similar experiments with Escherichia coli and CHX or cetylpyridinium chloride resulted in no significant increase in resistance. Antibiotic susceptibility profiles of the CHX-resistant P. aeruginosa cultures showed no cross-resistance, although some of the cultures were resistant to benzalkonium chloride.     

湖南省细菌耐药监测网2012—2021年铜绿假单胞菌耐药性监测报告

目的 了解2012—2021年湖南省细菌耐药监测网监测医院临床分离铜绿假单胞菌的分布及耐药性变迁情况。方法 采用纸片扩散法或自动化仪器法对临床分离株作药物敏感性(药敏)试验,按美国临床实验室标准化协会(CLSI)2022年版标准判断药敏试验结果,并应用WHONET 5.6软件进行统计分析。应用SPSS对数据进行趋势性检验(Cochran-armitage)及卡方检验。结果 2012—2021年湖南省耐药监测网共监测铜绿假单胞菌176 441株,其中,99.4%的菌株分离自住院患者,约70%的菌株分离自呼吸道标本;儿童(0～17岁)来源的铜绿假单胞菌占8.4%,成人来源的占91.6%。药敏结果显示,10年间铜绿假单胞菌对多黏菌素B最敏感,耐药率低于6%,对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、氨曲南、亚胺培南、阿米卡星、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、多黏菌素B的耐药率均呈下降趋势。共检出耐碳青霉烯类铜绿假单胞菌(CRPA)29 920株,该省CRPA 10年的平均分离率为18.0%。成人CRPA检出率为18.5%,高于儿童的12.3%,均呈下降趋势。结论 湖南省临...     

全国细菌耐药监测网2014—2019年临床分离非发酵革兰阴性杆菌耐药性变迁

目的了解全国临床分离非发酵革兰阴性杆菌的耐药性变迁。方法按照全国细菌耐药监测技术方案要求开展耐药监测工作,参考美国临床实验室标准化协会(CLSI)标准对2014—2019年全国1000余家医院上报至全国细菌耐药监测网的非发酵革兰阴性杆菌的临床资料进行总结和分析。结果非发酵革兰阴性杆菌主要分离自呼吸道标本(痰和支气管肺泡灌洗液)、尿、脓液和血,分别占83.6%,6.5%,4.0%和3.6%。铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌占分离细菌的比率分别为8.8%,7.3%,2.1%和0.5%。铜绿假单胞菌对多粘菌素B、阿米卡星和庆大霉素的敏感率分别为96.9%~98.2%,89.1%~94.0%和80.1%~86.4%;对哌拉西林和氨曲南的敏感率分别为66.7%~72.8%和58.8%~62.4%;对其余抗菌药物的敏感率维持在70.4%~81.7%。鲍曼不动杆菌对多粘菌素B、阿米卡星和米诺环素的敏感率分别为96.2%~98.0%,51.0%~58.0%和59.4%~63.4%,对其余抗菌药物的敏感率为35.8%~50.0%。嗜麦芽窄食单胞菌对米诺环素、复方磺胺甲口恶唑和左氧氟沙星的敏感率分别为93.0%~95.3%,89.3%~91.4%和85.0%~86.6%,对替卡西林/克拉维酸和氯霉素的敏感率为37.4%~50.3%和46.6%~51.1%。洋葱伯克霍尔德菌对替卡西林/克拉维酸和氯霉素的敏感率分别为18.5%~37.0%和54.4%~62.2%,对其余抗菌药物的敏感率维持在64.7%~86.8%。耐碳青霉烯类铜绿假单胞菌检出率呈下降趋势,而耐碳青霉烯类鲍曼不动杆菌检出率呈现先上升后下降的变化趋势。结论非发酵革兰阴性杆菌对常用抗菌药物的敏感性无明显变化,耐碳青霉烯类铜绿假单胞菌和鲍曼不动杆菌检出率呈下降趋势。     

Nosocomial outbreak of severe Pseudomonas aeruginosa infections in haematological patients

From June to September 1988, an outbreak of Pseudomonas aeruginosa infections in neutropenic patients admitted to the Haematological Wards of Ospedali Riuniti in Bergamo, Italy, was detected. Out of 11 cases of P. aeruginosa infections, 8 were bacteremic. Of these, 7 died within few days of onset (mortality rate: 87.5%). Consequently, possible sources of infection were investigated, and moist areas of the hospital environment were shown to be highly contaminated by P. aeruginosa. A clinical and microbiological follow-up of patients admitted to the Haematological Wards was performed for a 10 month period following the outbreak. Adequate measures for cleaning and disinfection were shown to reduce the frequency of P. aeruginosa hospital infections.     

Epidemiological characteristics ofPseudomonas aeruginosa strains causing infection in an Italian general hospital

During the 1989 calendar year,P. aeruginosa caused clinical infections in 0.46% of patients admitted to Ospedali Riuniti (a general hospital), Bergamo, Italy. Strains (n=267) ofP. aeruginosa were collected during this period, and epidemiological characteristics were studied. The mean prevalence ofP. aeruginosa infection in inpatients was 1.1% (range 0.06–7.3), whereas outpatients showed a significantly lower prevalence of infection (0.05%). Strains were recovered from inpatients of surgical wards (n=126; 47.2%), and outpatients (n=15; 5.6%). Males were more often affected than females (2.7:1). Infection of the urinary tract was the most common (34.1%).Pseudomonas aeruginosa was also involved in lower respiratory tract infections (18.7%) and septicaemia (17.6%). Four typing methods were performed, i.e. serotyping, antibiotyping, pyocin typing, and restriction endonuclease analysis (REA). Serotypes 0:11 and 0:6 were endemic in the hospital. Some serotypes correlated with specific clinical wards. Pyocin typing was an unreliable epidemiological tool. However, antibiotyping showed the presence of some epidemic clusters, probably related to the antibiotic consumption of the patients. REA suggested the circulation of endemicP. aeruginosa strains in both the obstetrics and neurosurgery wards.     

Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a paediatric surgical unit associated with tap-water contamination

An outbreak of 14 cases of urinary tract infections by Pseudomonas aeruginosa, including six symptomatic infections, occurred from September to November 1994 in a paediatric surgical unit. During the outbreak, urine samples from patients and multiple samples from the environment of patients were tested for the presence of P. aeruginosa. Bacterial isolates were studied by pulsed field gel electrophoresis. Genotypic analysis showed that most of the isolates from children were different. Multiple P. aeruginosa isolates were also found in the tap water, as the only putative source of contamination. Two of these isolates were identified in two infected patients, indicating possible direct contamination of patients via tap water and this was related to the distal colonization of faucets. Bacteria were eradicated from tap water by replacement of taps. The cluster of cases of P. aeruginosa urinary infection was, therefore, related to multiple contaminations through tap water. These results illustrate an unexpected risk of nosocomial infection and emphasizes the importance of checking tap water to prevent bacterial contamination through handwashing in contaminated water.     

Experimental studies on the protective efficacy of a Pseudomonas aeruginosa vaccine

Pseudomonas aeruginosa vaccine (PV) containing cell proteins with molecular weight (M_r) 20 000–100 000 and up to 0.08% ( ) admixture of lipopolysaccharide was obtained by water—salt extraction and subsequent ultrafiltration. PV protects mice against experimental P. aeruginosa infection, stimulates production of specific protective antibodies in rabbit and does not provoke obvious toxicity in laboratory animals.     

Pseudomonas aeruginosa orbital cellulitis in four neutropenic patients

Four neutropenic patients on a haematology ward developed orbital cellulitis due to different strains of Pseudomonas aeruginosa over a 7-month period. Investigation of patients and the ward environment revealed two P. aeruginosa isolates indistinguishable from the infecting strains in a plastic washing bowl and a sink in a single cubicle respectively. These items were unlikely to have been the sources of the infecting strains but were a potential cross infection hazard. Treatment of orbital cellulitis is discussed briefly.