CAJ | 학술논문

目的：探讨多重药耐药医院获得性嗜麦芽窄食单胞菌（SMA）耐药途径阻断后的药敏情况，为其临床治疗与合理用药提供试验依据和思路。方法选取2013年11月至2014年10月临床分离的SM A 87株作为监测对象，通过阻断SMA耐药性的TopoⅡα途径，来观察其对医院获得性SMA多重药耐药性的生长、增殖及转移的抑制作用。结果 SM A菌株检测在呼吸科检出率最高，为25．29％，高于其他科室来源菌株检出率；在痰液中检出率最高，为35．63％，高于其他标本类型菌株，差异均有统计学意义（P＜0．05）；阻断SMA耐药性 TopoⅡα途径前，87株SM A的药敏检测结果显示，对复方磺胺甲噁唑的敏感率最高，为87．36％；对亚胺培南耐药率最高，为100．00％，分别高于其他抗菌药物的敏感率和耐药率，差异均有统计学意义（P＜0．05）；阻断SMA耐药性 TopoⅡα途径后， SMA对亚胺培南耐药率最高，为83．91％；对复方磺胺甲噁唑的敏感率最高，为94．25％，与阻断SMA耐药性TopoⅡα途径前比较，差异无统计学意义（P＞0．05）；氨曲南、头孢吡肟、亚胺培南的敏感性较阻断SMA耐药性TopoⅡα途径前增加，耐药性下降，差异均有统计学意义（P＜0．05）。结论通过阻断SMA耐药性的 TopoⅡα途径来沉默基因的表达，对医院获得性SM A耐药性的生长、增殖及转移有一定抑制作用，值得临床推广。
목적：탐토다중약내약의원획득성기맥아착식단포균（SMA）내약도경조단후적약민정황，위기림상치료여합리용약제공시험의거화사로。방법선취2013년11월지2014년10월림상분리적SM A 87주작위감측대상，통과조단SMA내약성적TopoⅡα도경，래관찰기대의원획득성SMA다중약내약성적생장、증식급전이적억제작용。결과 SM A균주검측재호흡과검출솔최고，위25．29％，고우기타과실래원균주검출솔；재담액중검출솔최고，위35．63％，고우기타표본류형균주，차이균유통계학의의（P＜0．05）；조단SMA내약성 TopoⅡα도경전，87주SM A적약민검측결과현시，대복방광알갑오서적민감솔최고，위87．36％；대아알배남내약솔최고，위100．00％，분별고우기타항균약물적민감솔화내약솔，차이균유통계학의의（P＜0．05）；조단SMA내약성 TopoⅡα도경후， SMA대아알배남내약솔최고，위83．91％；대복방광알갑오서적민감솔최고，위94．25％，여조단SMA내약성TopoⅡα도경전비교，차이무통계학의의（P＞0．05）；안곡남、두포필우、아알배남적민감성교조단SMA내약성TopoⅡα도경전증가，내약성하강，차이균유통계학의의（P＜0．05）。결론통과조단SMA내약성적 TopoⅡα도경래침묵기인적표체，대의원획득성SM A내약성적생장、증식급전이유일정억제작용，치득림상추엄。
Objective To investigate the drug susceptibility situation after blocking TopoⅡα drug resistance pathway in multi‐drug resistant hospital‐acquired Stenotrophomonas maltophilia (SMA) to provide the experimental evidence and thinking for its clinical treatment and rational drug use .Methods 87 clinically isolated strains of SMA in our hospital from November 2013 to October 2014 were selected as the monitoring objects .By blocking the TopoⅡαpathway of SMA drug‐resistance ,its inhibiting role on the SMA growth ,proliferation and transferring was ob‐served .Results The detection rate of SMA strain was highest(25 .29% ) in the respiration department ,which was higher than the detection rate in the other departments ;the highest detection rate was in sputum(35 .63% ) ,which was higher than that in the other types of specimen ,the difference was statistically significant(P<0 .05);before bloc‐king the SMA drug‐resistance Topo Ⅱαpathway ,the drug susceptibility test results of 87 strains of SMA displayed that the sensitive rate to compound sulfamethoxazole was highest(87 .36% ) and the resistance rate to imipenem was highest (100 .00% ) ,which were higher than the sensitivity rate and resistance rate of other antibacterial drugs re‐spectively ,the differences were statistically significant(P<0 .05);after blocking the SMA drug resistance Topo Ⅱαpathway ,SMA had the highest resistance rate to imipenem(83 .91% ) and the highest sensitive rate(94 .25% ) to compound sulfamethoxazole ,the differences had no statistical significance compared with before blocking (P>0 .05);while the its sensitivity to aztreonam ,cefepime and imipenem was increased comparing with before blocking the SMA drug resistance Topo Ⅱαpathway ,and the drug resistance was dropped ,the differences were statistically significant (P<0 .05) .Conclusion Silencing gene expression by blocking the Topo Ⅱαpathway of SMA has certain inhibitory effect on the growth ,proliferation and transferring of hospital acquired SMA ,which is worthy of clinical promotion .