CAJ | 학술논문

目的分析烧伤病房亚胺培南耐药铜绿假单胞菌(IRPA)的耐药情况及携带的耐药基因. 方法 2011年6月-2012年6月,收集广州市中西医结合医院烧伤住院患者创面分泌物、痰液和静脉导管表面附着物分离的30株IRPA.采用K-B纸片琼脂扩散法,测定菌株对头孢他啶、阿米卡星、环丙沙星等12种临床常用抗生素的耐药性.采用亚胺培南-2-巯基乙醇协同试验筛选产金属β内酰胺酶菌株.提取IRPA质粒转化感受态细胞培养转化菌株,鉴定转化菌株对亚胺培南的耐药性和产金属β内酰胺酶情况.采用PCR法检测IRPA及转化菌株的blaIMP、blaVIM、blaOXA-1、blaOXA-2和blaOXA-10基因.总结产金属β内酰胺酶和OXA酶IRPA的耐药情况. 结果 30株IRPA对12种抗生素耐药率均较高,达到60.0％及以上.共筛选出6株产金属β内酰胺酶的IRPA.24株转化菌株对亚胺培南耐药,其中6株为产金属β内酰胺酶菌株.30株IRPA中6株携带bla VIM基因,其相应的转化菌株也携带blaVIM基因；20株携带blaOXA.基因,其相应的转化菌株也携带blaOXA-10基因；无携带blaIMP、blaOXA-1或blaOXA-2基因菌株.2株IRPA及其转化菌株均同时携带blaVIM和bla OXA-10基因.单产金属β内酰胺酶或OXA酶的IRPA在耐药程度上没有明显区别,对β内酰胺类抗生素耐药率均较高,对氨基糖苷类抗生素具有一定的敏感性；同时产前述2种酶的IRPA对12种抗生素均表现出耐药性. 结论广州市中西医结合医院烧伤病房分离的IRPA为多药耐药菌株,主要产B、D类碳青霉烯酶.
목적 분석소상병방아알배남내약동록가단포균(IRPA)적내약정황급휴대적내약기인. 방법 2011년6월-2012년6월,수집엄주시중서의결합의원소상주원환자창면분비물、담액화정맥도관표면부착물분리적30주IRPA.채용K-B지편경지확산법,측정균주대두포타정、아미잡성、배병사성등12충림상상용항생소적내약성.채용아알배남-2-구기을순협동시험사선산금속β내선알매균주.제취IRPA질립전화감수태세포배양전화균주,감정전화균주대아알배남적내약성화산금속β내선알매정황.채용PCR법검측IRPA급전화균주적blaIMP、blaVIM、blaOXA-1、blaOXA-2화blaOXA-10기인.총결산금속β내선알매화OXA매IRPA적내약정황. 결과 30주IRPA대12충항생소내약솔균교고,체도60.0％급이상.공사선출6주산금속β내선알매적IRPA.24주전화균주대아알배남내약,기중6주위산금속β내선알매균주.30주IRPA중6주휴대bla VIM기인,기상응적전화균주야휴대blaVIM기인；20주휴대blaOXA.기인,기상응적전화균주야휴대blaOXA-10기인；무휴대blaIMP、blaOXA-1혹blaOXA-2기인균주.2주IRPA급기전화균주균동시휴대blaVIM화bla OXA-10기인.단산금속β내선알매혹OXA매적IRPA재내약정도상몰유명현구별,대β내선알류항생소내약솔균교고,대안기당감류항생소구유일정적민감성；동시산전술2충매적IRPA대12충항생소균표현출내약성. 결론 엄주시중서의결합의원소상병방분리적IRPA위다약내약균주,주요산B、D류탄청매희매.
Objective To analyze the drug resistance and drug resistance genes of imipenem-resistant Pseudomonas aeruginosa (IRPA) strains isolated from burn wards.Methods From June 2011 to June 2012,30 strains of IRPA were isolated from wound excretion,sputum,and venous catheter attachment from burn patients hospitalized in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine.Drug resistance of the IRPA to 12 antibiotics commonly used in clinic,including ceftazidime,amikacin,ciprofloxacin,etc.,was tested with K-B paper agar disk diffusion method.Metallo-β-1actamase (MBL)-producing IRPA was detected by synergism test with imipenem-2-mercaptoethanol.Plasmid of IRPA was extracted,and it was inserted into competent cells,producing transformation strains (TSs).Drug resistance of TSs to imipenem and the MBL-producing TSs were detected.The genes bla IMP,bla VIM,bla OXA-1,bla OXA-2 and bla OXA-10 of IRPA and the TSs were detected by polymerase chain reaction.The drug resistance of IRPA producing MBL or OXA enzyme was summed up.Results The sensitive rates of the 30 strains of IRPA to the 12 antibiotics were equal to or above 60.0％.Six strains of MBL-producing IRPA were screened.Twenty-four TSs were resistant to imipenem,and 6 strains among them were MBL-producing positive.Among the 30 strains of IRPA,6 strains and their corresponding TSs carried bla VIM ; 20 strains and their corresponding TSs carried bla OXA-10 ; no strain was detected to carry bla IMP,bla OXA-1 or bla OXA-2· Two strains and their corresponding TSs were detected carrying both bla VIM and bla OXA-10.No significant difference of drug resistance was observed between strains producing only MBL or OXA enzyme,with the same high resistance to β-lactam antibiotics and some degree of sensitivity to aminoglycoside antibiotics.Strains producing enzymes MBL and OXA were all resistant to the 12 antibiotics.Conclusions IRPA strains isolated from burn wards of Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine are multidrug-resistant,and they mainly produce type B and D carbapenemases.