CAJ | 학술논문

目的了解铜绿假单胞菌Ⅲ型分泌系统(TTSS)的毒力基因exo U、exo S的临床意义.方法来自5家医院临床分离的铜绿假单胞菌189株,采用PCR调查毒力基因exo U、exo S在铜绿假单胞菌中的发生率;微量稀释法测定抗菌药物对细菌的MIC;对携带exo U+/exo S-型或exo U-/exo S+型细菌(从痰液分离)的60例阳性患者资料进行回顾性分析,观察患者临床特征和转归情况.对数据进行x2检验. 结果 PCR检测显示,161株携带TTSS,其中120株exo U-/exo S+,31株exo U+/exo S-,3株exo U+/exo S+,7株exo U-/exo S-;剩余28株为TTSS阴性.痰液标本和血液标本均以exo U-/exo S+表型最常见,分别占其TTSS阳性菌株的72.0%(72/100)和81.5%(44/54).药物敏感试验分析,TTSS阴性菌株对头孢哌酮/舒巴坦、头孢他啶、阿米卡星、头孢吡肟的耐药性均高于TTSS阳性菌株(x2值分别为10.1、16.1、9.3、33.8,P值均小于0.01).exo U+/exo S-菌株和exo U-/exo S+菌株的药物敏感试验结果相似(x2值为0.08～2.04,P值均大于0.05).回顾性分析表明,exo U+/exo S-型患者临床特征是多有气管插管史、ICU住院史、抗感染治疗多采用联合用药,以铜绿假单胞菌感染居多;exo U-/exo S+的临床特征是多存在肺部基础疾病,预后好于前者,以铜绿假单胞菌定植居多. 结论 TTSS存在于大多铜绿假单胞菌临床菌株中,检查痰液标本来源的铜绿假单胞菌exo U或exo S基因,对分析患者临床特征和治疗转归有一定指导意义.
목적 료해동록가단포균Ⅲ형분비계통(TTSS)적독력기인exo U、exo S적림상의의.방법 래자5가의원림상분리적동록가단포균189주,채용PCR조사독력기인exo U、exo S재동록가단포균중적발생솔;미량희석법측정항균약물대세균적MIC;대휴대exo U+/exo S-형혹exo U-/exo S+형세균(종담액분리)적60례양성환자자료진행회고성분석,관찰환자림상특정화전귀정황.대수거진행x2검험. 결과 PCR검측현시,161주휴대TTSS,기중120주exo U-/exo S+,31주exo U+/exo S-,3주exo U+/exo S+,7주exo U-/exo S-;잉여28주위TTSS음성.담액표본화혈액표본균이exo U-/exo S+표형최상견,분별점기TTSS양성균주적72.0%(72/100)화81.5%(44/54).약물민감시험분석,TTSS음성균주대두포고동/서파탄、두포타정、아미잡성、두포필우적내약성균고우TTSS양성균주(x2치분별위10.1、16.1、9.3、33.8,P치균소우0.01).exo U+/exo S-균주화exo U-/exo S+균주적약물민감시험결과 상사(x2치위0.08～2.04,P치균대우0.05).회고성분석표명,exo U+/exo S-형환자림상특정시다유기관삽관사、ICU주원사、항감염치료다채용연합용약,이동록가단포균감염거다;exo U-/exo S+적림상특정시다존재폐부기출질병,예후호우전자,이동록가단포균정식거다. 결론 TTSS존재우대다동록가단포균림상균주중,검사담액표본래원적동록가단포균exo U혹exo S기인,대분석환자림상특정화치료전귀유일정지도의의.
Objective To study the clinical significance of virulence genes exo U and exo S of type secretion system (TTSS) of Pseudomonas aeruginosa (PA). Methods One hundred and eighty-nine clinical isolates of PA were collected from five hospitals. The incidence of virulence genes exo U and exo S in PA were determined with PCR. Minimum inhibitory concentration of anti-bacterial drug for PA was deter mined with microdilution method. The clinical features and outcomes of 60 hospitalized patients colonized or infected with exo U +/exo S - postive or exo U -/exo S + postive PA isolated from sputum were analyzed retrospectively. Data were processed with chi-square test. Results Among the 189 PA isolates, 85.2% (161/189) harbored TTSS genes, including exo U -/exo S + type (120 isolates), exo U +/exo S- type (31 isolates), exo U -/exo S - type (7 isolates), and exo U +/exo S + type (3 isolates). 72.0% (72/ 100) isolates from sputum and 81.5% (44/54) isolates from blood belonged to exo U -/exo S + genotype. Compared with those of TTSS-negative isolates, the antimicrobial resistance of TTSS-positive isolates to cef operazone/sulbactam, ceftazidime, amikacin, and cefepime were lower (withx2 value respectively 10. 1, 16.1, 9.3, 33.8, P values all below 0.01 ). The antimicrobial resistance to all examined drug between exo U-/exo S + type and exo U +/exo S - type isolates was close ( withx2 values from 0. 08 to 2.04, P values all above 0.05). Patients detected with exo U +/exo S - positive PA isolated from sputum were significantly associated with PA infection, and they usually had history of tracheal intubation, ICU hospitalization, and combined use of drugs for anti-infection treatment. Patients detected with exo U -/exo S + positive PA iso lated from sputum were significantly associated with PA colonization, which had basic lung disease and better outcome than the former infection type. Conclusions The TTSS exists in most clinical isolates of PA. De tection of exo U or exo S of PA isolated from sputum is helpful for the analysis of clinical features and out come of patients.