CAJ | 학술논문

目的明确我院老年病人临床分离铜绿假单胞菌的耐药性、同源性及耐碳青霉烯菌株的基因型。方法收集我院2006年5月-2009年5月自临床老年病人分离的262株铜绿假单胞菌，纸片扩散法测定其对16种抗菌药物的耐药性；琼脂稀释法和E test法测定耐碳青霉烯菌株对14种抗菌药物的MIC值，PCR扩增及克隆测序分析金属酶基因型。脉冲场凝胶电泳(PFGE)分析携带金属酶基因型菌株的同源性。结果 262株铜绿假单胞菌中筛选到104株耐碳青霉烯。104株耐碳青霉烯铜绿假单胞菌对氨苄西林/舒巴坦、头孢哌酮/舒巴坦两个含舒巴坦制剂药物耐药率分别为78.9％和35.9％,对多黏菌素E耐药率最低为6.0％，对米诺环素耐药率58.3％，其余抗菌药物耐药率均大于70.0％；104株亚胺培南耐药铜绿假单胞菌中12株携带金属酶基因，10株检测到有携带VIM-2基因的1类整合子。PFGE分型中12株菌株属于5个克隆株。结论在我院流行的亚胺培南耐药铜绿假单胞菌中，金属酶基因不是最主要的基因型，金属β-内酰胺酶均为VIM-2型金属酶，耐药基因盒分布于不同的1类整合子中，整合子播散是最主要的流行方式。
목적 명학아원노년병인림상분리동록가단포균적내약성、동원성급내탄청매희균주적기인형。방법 수집아원2006년5월-2009년5월자림상노년병인분리적262주동록가단포균，지편확산법측정기대16충항균약물적내약성；경지희석법화E test법측정내탄청매희균주대14충항균약물적MIC치，PCR확증급극륭측서분석금속매기인형。맥충장응효전영(PFGE)분석휴대금속매기인형균주적동원성。결과 262주동록가단포균중사선도104주내탄청매희。104주내탄청매희동록가단포균대안변서림/서파탄、두포고동/서파탄량개함서파탄제제약물내약솔분별위78.9％화35.9％,대다점균소E내약솔최저위6.0％，대미낙배소내약솔58.3％，기여항균약물내약솔균대우70.0％；104주아알배남내약동록가단포균중12주휴대금속매기인，10주검측도유휴대VIM-2기인적1류정합자。PFGE분형중12주균주속우5개극륭주。결론 재아원류행적아알배남내약동록가단포균중，금속매기인불시최주요적기인형，금속β-내선알매균위VIM-2형금속매，내약기인합분포우불동적1류정합자중，정합자파산시최주요적류행방식。
Objective To identify the antibiotic resistance, homology of imipenem-resistant Pseudomonas aeruginosa strains isolated from older in Zhejiang Hospital and the carbapenemases determinants of imipenem-resistant strains. Methods Two hundred and sixty-two strains of Pseudomonas aeruginosa were isolated through May 2006 to May 2009 from older in Zhejiang Hospitals. K-B method was used to determine the 16 antimicrobial agents resistance of these 262 strains. The MICs of strains to 14 antimicrobial agents were determined by agar dilution and E test method. The coding sequence of Metallo-β-lactamases (MBL) were amplified, PCR products were purified, cloned and sequenced. The homology of these isolates was analyzed by pulse-field gel electrophoresis(PFGE). Results One hundred and four strains of imipenem-resistant Pseudomonas aeruginosa were screened from 262 strains. The resistant rates of 104 isolates of Pseudomonas aeruginosa to ampicillin/sulbactam and cefoperazone/sulbactam were 78.9％ and 35.9％ ; polymyxin E had a minimal resistance of 6.0％ ; minocycline had a resistance rate of 58.3％. The resistant rates to other antimicrobial agents were more than 70.0％. Twelve imipenem-resistant Pseudomonas aeruginosa strains contained MBL gene and two kinds of integron were detected from 10 of these 12 strains. Twelve strains of Pseudomonas aeruginosa belonged to 5 epidemic PFGE-clone. Conclusion All of the imipenem-resistant Pseudomonas aeruginosa which had cause outbreaks in Zhejiang Hospital. MBL were not the most popular gene type. All of the MBL gene types were VIM-2. The blaVIM-2 gene cassettes located in diflerent class 1 integrons. The integrons dissemination was the most important style of strains spread.