国内铜绿假单胞茵对喹诺酮类药物耐药机制的Meta分析

目的 系统评价我国铜绿假单胞菌对喹诺酮类药物的相关耐药机制。 方法 计算机检索CNKI、WanFang Data、CBM、VIP、PubMed、EMbase和The Cochrane Library数据库，检索时限均从建库至2012年12月，查找来自中国的有关铜绿假单胞菌对喹诺酮类药物耐药机制研究的相关文献。按照纳入与排除标准筛选文献后，采用RevMan 5.0软件进行Meta分析。 结果 共纳入19篇文献，合计723株耐喹诺酮类铜绿假单胞菌。统计分析结果显示：gyrA、gyrB、parC和parE基因检出率在淮河以北地区分别为88.0%、13.3%、31.4%和16.7%；在淮河以南地区分别为64.6%、50.0%、35.4%和11.5%。质粒介导的耐药基因aac（6’）-Ib-cr淮河以北地区检出率为0（0/66），淮河以南地区检出率则为39%（25/64），主动泵出系统表达率为68.1%。 结论 在我国，铜绿假单胞菌耐喹诺酮类药物的机制以gyrA基因突变为主，其主动泵出系统是重要的耐药机制，而DNA拓扑异构酶Ⅳ的异常及质粒介导的耐药是次要机制。

Resistance of Pseudomonas Aeruginosa to Quinolone in China： A Meta-Analysis

Objective To systematically review the resistance of pseudomonas aeruginosa to quinolone in China.
Methods Such databases as CNKI, WanFang Data, CBM, VIP, PubMed, EMbase and The Cochrane Library were electronically searched from inception to December 2012, for relevant studies on the resistance mechanism of pseudomonas aeruginosa to quinolone. Two reviewers independently screened literature according to inclusion and exclusion criteria. Then, meta-analysis was performed using RevMan 5.0 software.
Results Totally 19 studies were included, involving 723 strains of quinolone-resistant pseudomonas aeruginosa. The statistical results showed that, in the areas to the north of Huai River, the detection rates of gyrA, gyrB, parC and parE were 88.0%, 13.3%, 31.4% and 16.7%, respectively; and in the areas to the south of Huai River, they were 64.6%, 50.0%, 35.4% and 16.7%, respectively. The detection rates of plasmid mediated resistant genes aac （6’）-Ib-cr was 0 （0/66） in the areas to the north of Huai River, and 39% （25/64） in the areas to the south of Huai River. The outer membrane protein expression rate of active efflux system was 68.1%.
Conclusion In China, gyrA gene mutation and the active efflux system mainly account for pseudomonas aeruginosa’s resistance to quinolone. DNA topoisomerase IV abnormalities and plasmid mediated resistance is the secondary mechanism.