| 武文君,王炜,荆鹏伟,等.碳青霉烯耐药铜绿假单胞菌的耐药特点和多位点序列分型[J].安徽医药,2025,29(1):131-136. |
| 碳青霉烯耐药铜绿假单胞菌的耐药特点和多位点序列分型 |
| The drug resistance characteristics and multilocus sequence typing of carbapenem-resistant Pseudomonas aeruginosa |
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| DOI：10.3969/j.issn.1009-6469.2025.01.027 |
| 中文关键词: 铜绿假单胞菌 碳青霉烯类 耐药性 多位点序列分型(MLST) 抗菌药物 |
| 英文关键词: Pseudomonas aeruginosa Carbapenems Drug resistance Multilocus sequence typing Antibacterial drugs |
| 基金项目: |
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| 中文摘要: |
| 目的了解临床分离碳青霉烯(亚胺培南、美罗培南)耐药的铜绿假单胞菌( carbapenem resistant pseudomonas aerugino-sa，CRPA)的耐药情况和遗传分型，为临床合理化用药和医院感染控制工作提供依据。方法收集 2021年 7月至 2022年 6月河南中医药大学第一附属医院临床分离的非重复碳青霉烯耐药的铜绿假单胞菌 60株进行鉴定和药敏试验，分析临床分布和标本来源。随机选取其中 35株 CRPA，利用多位点序列分型( multilocus sequence typing，MLST)扩增铜绿假单胞菌的 7个管家基因 acsA、aroE、guaA、mutL、nuoD、ppsA和 trpE，PCR扩增测序后采用 DNAstar和 PHYLOViZ 2.0等软件对分离的 CRPA进行遗传差异性分析。结果 60株 CRPA主要分布在呼吸科、康复科、重症监护病房。标本类型以痰液为主( 63.3%)，其次为肺泡灌洗液( 28.3%)。除多黏菌素、阿米卡星、庆大霉素外，对其他抗菌药物的耐药率均为 40%以上，与同期分离的碳青霉烯敏感铜绿假单胞菌( carbapenem sensitive pseudomonas aeruginosa，CSPA)相比，除多黏菌素外， CRPA分离组对阿米卡星( 23.3%)、头孢吡肟( 58.3%)、头孢他啶( 48.3%)、环丙沙星( 55.0%)、哌拉西林 /他唑巴坦( 45.0%)、氨曲南(56.7%)、美罗培南( 78.3%)等抗菌药物的耐药率显著高于 CSPA组，差异有统计学意义( P<0.05)。 MLST分析显示 35株 CRPA可分为 25个 ST型，其中优势 ST为 ST1182。该研究发现 1种新的等位基因 trpE316，3种新的 ST型别，分别为 ST3978、ST3979、ST3980。结论 CRPA主要来源于呼吸道，多见于呼吸科， CRPA耐药形势严峻，应结合药敏结果和流行病学分析，有针对性地采取干预措施。 MLST分析的结果显示 ST型存在多样化，克隆类型多样化，提示这些菌株的遗传背景也极其复杂多变。 |
| 英文摘要: |
| Objective To investigate the clinical distribution and genetic phenotypes of carbapenem-resistant Pseudomonas aerugino-sa (CRPA), and provide basis for clinical rational drug use and nosocomial infection control. Methods Sixty strains of non-repeated carbapenem-resistant aeruginosa isolated clinically from July 2021 to June 2022 were collected from The First Affiliated Hospital ofHe'nan University of Chinese Medicine for identification and drug sensitivity testing, and the clinical distribution and source of speci-mens were analyzed. Thirty five CRPA strains were randomly selected, and the seven housekeeping genes acsA, aroE, guaA, mutL, nu-oD, ppsA and trpE of Pseudomonas aeruginosa were amplified using the multi-locus sequence typing method (MLST), and the PCR am-plification and sequencing were used to analyze the genetic variability of the isolated CRPAs using software such as DNAstar and PHY.LOViZ 2.0. Results Sixty CRPA strains were mainly isolated from the respiratory department, rehabilitation department, and ICU, themain type of specimen was sputum (63.3%). The resistance rates to antibiotics were more above 40%, except polymyxin, amikacin andgentamicin. Compared with carbapenem-susceptible Pseudomonas aeruginosa (CSPA) isolated during the same period, the CRPAstrains had significantly higher resistance rates to antibiotics such as amikacin (23.3%), cefepime (58.3%), ceftazidime (48.3%), cipro-floxacin (55.0%), piperacillin/tazobactam (45.0%), aztreonam (56.7%), and meropenem (78.3%), except polymyxin, and the differencewas statistically significant (P<0.05). MLST analysis showed that 35 CRPA strains belonged to 25 different ST types, of which the domi-nant STs was ST1182. In this study, a new allele trpE316, three new ST phenotypes, ST3978, ST3979 and ST3980 were identified.Conclusions Respiratory tract infection is the main cause of CRPA in this study, which is more common in the respiratory depart-ment. The CRPA resistance situation is serious, and targeted interventions should be taken in conjunction with drug sensitivity resultsand epidemiological analysis. The results of MLST analysis show the existence of diversified ST types and clone types, suggesting thatthe genetic background of these strains is also complex and variable. |
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