【摘要】：[目的]分析昆明醫(yī)科大學第一附屬醫(yī)院銅綠假單胞菌的耐藥情況和多重耐藥銅綠假單胞菌的感染危險因素,為臨床合理選用抗生素及預防多重耐藥銅綠假單胞菌感染提供實驗室依據(jù);研究銅綠假單胞菌中mexA、mexB及oprM基因的表達,為進一步了解銅綠假單胞菌的耐藥機制提供依據(jù)。[方法]收集2015年1月1日-2016年12月31日昆明醫(yī)科大學第一附屬醫(yī)院各科室住院患者送檢標本中分離的院內感染銅綠假單胞菌。用VITEK-2全自動藥物敏感試驗分析儀進行銅綠假單胞菌的藥物敏感試驗。根據(jù)藥物敏感試驗結果將患者分為多重耐藥銅綠假單胞菌感染組(MDRPA)和非多重耐藥銅綠假單胞菌感染組(NMDRPA)�；仡櫺允占~綠假單胞菌感染患者的臨床資料,分析多重耐藥銅綠假單胞菌的感染危險因素。逆轉錄熒光定量聚合酶鏈反應檢測2016年1月1日-2016年12月31日收集的銅綠假單胞菌中編碼MexAB-OprM主動外排系統(tǒng)的mexA、mexB及oprM基因。分析mexA、mexB、oprM基因高表達與銅綠假單胞菌對抗生素耐藥及多重耐藥性之間的關系。[結果]本次研究共收集銅綠假單胞菌242株,其中多重耐藥菌株為68株,占28.1%;主要標本來源為呼吸道標本(59.9%),其次是尿液標本(11.2%);242株銅綠假單胞菌主要分布于ICU(24.4%),其次為神經(jīng)外科(16.1%)。銅綠假單胞菌對抗生素的耐藥率由高到低依次為:亞胺培南(36.7%)、美羅培南(30,4%)、頭孢他啶(23.8%)、哌拉西林(23.3%)、環(huán)丙沙星(20.4%)、妥布霉素(19.9%)、慶大霉素(19.5%)、頭孢吡肟(18.8%)、哌拉西林-他唑巴坦(17.8%)、左氧氟沙星(17.6%)、阿米卡星(12.1%)。分離自ICU患者的銅綠假單胞菌耐藥率為15.5-57.6%,高于非ICU科室患者分離株(11-29.8%);分離自兒童、成人及老年人患者菌株耐藥率分別為0-25%、18.0%-41.4%和4.6%-33.3%。單因素分析表明標本采集前一個月內入住ICU、住院天數(shù)、使用氟喹諾酮類抗生素、使用碳青霉烯類抗生素、使用糖肽類抗生素、聯(lián)合用藥、抗生素使用時間、留置尿管、留置胃管、深靜脈置管、氣管插管、吸痰、使用呼吸機、體外引流、慢性腎功能衰竭及中性粒細胞減少在MDRPA組和NMDRPA組間的分布差異具有統(tǒng)計學意義(P0.05);多因素分析表明碳青霉烯類抗生素和慢性腎功能衰竭在MDRPA組和NMDRPA組間的分布差異具有統(tǒng)計學意義(P0.05)。同時我們的研究顯示2016年1月1日-2016年12月31日共收集銅綠假單胞菌102株。102株銅綠假單胞菌中mexA、mexB及oprM基因高表達菌株檢出率分別為65.7%、39.2%及35.3%。mexA基因高表達與銅綠假單胞菌對哌拉西林、哌拉西林-他唑巴坦、頭孢他啶及頭孢吡西的耐藥有關;mexA、mexB基因高表達與銅綠假單胞菌的多重耐藥性有關。[結論]銅綠假單胞菌對每種抗生素的耐藥率各不相同,分離自不同科室、不同年齡段患者的菌株對每種抗生素的耐藥率也各不相同,臨床醫(yī)生應根據(jù)藥物敏感試驗結果合理選用抗生素。碳青霉烯類抗生素和慢性腎功能衰竭是多重耐藥銅綠假單胞菌感染的獨立危險因素。mexA基因的高表達參與銅綠假單胞菌對β-內酰胺類抗生素的耐藥,mexA、mexB基因的高表參與銅綠假單胞菌多重耐藥性的形成。
[Abstract]:[Objective] To analyze the drug resistance of P. aeruginosa in the First Affiliated Hospital of Kunming Medical University and the risk factors of multiple drug-resistant Pseudomonas aeruginosa, and provide the basis for the rational selection of antibiotics and the prevention of multiple drug-resistant Pseudomonas aeruginosa infection. The expression of mexA, mexB and oprM in P. aeruginosa was studied.[Method] Collect the nosocomial infection of P. aeruginosa in the hospital of the first affiliated hospital of Kunming Medical University on Jan. 1, 2015-December 31, 2016. The drug-sensitive test of P. aeruginosa was performed with the VITEK 2 full-automatic drug-sensitive test analyzer. The patient was divided into multiple drug-resistant Pseudomonas aeruginosa infection groups (MDRPAs) and non-multiple drug-resistant Pseudomonas aeruginosa infection groups (NMDRPAs) according to the drug-sensitive test results. The clinical data of the patients with Pseudomonas aeruginosa were retrospectively collected and the risk factors of the infection of the multiple drug-resistant Pseudomonas aeruginosa were analyzed. The mexA, mexB, and oprM genes of the MexAB-OprM active efflux system were detected in Pseudomonas aeruginosa collected on 1/ 1/ 2016 to 31-Dec-2016 by RT-PCR. The relationship between the high expression of mexA, mexB and oprM and the drug resistance and multiple drug resistance of P. aeruginosa was analyzed.[Results] In this study, 242 strains of P. aeruginosa were collected. The multiple drug-resistant strains were 68 strains, accounting for 28.1%. The main samples were respiratory tract specimens (55.9%), followed by urine specimens (11.2%), 242 strains of P. aeruginosa were mainly distributed in the ICU (2.4%). followed by neurosurgery (16.1%). The resistance rate of Pseudomonas aeruginosa to antibiotics was from high to low in the order of imipenem (32.7%), meropenem (30, 4%), ceftriaxone (23. 8%), methicillin (23. 3%), ciprofloxacin (23.4%), butramycin (19.9%), and gentamicin (19. 5%). Ceftaxime (1.8%), penethamate-other sulbactam (17.8%), levofloxacin (17.6%), and amikacin (12.1%). The drug-resistant rate of P. aeruginosa isolated from ICU patients was 15. 5-55.7%, which was higher than that in non-ICU (11-29. 8%). The drug-resistant rates of the isolates from children, adults and the elderly were 0-25%, 18. 0%-41.4% and 4.6%-33.3%, respectively. The single-factor analysis showed that in the ICU and the number of days of the stay in the ICU, the use of carbapenem antibiotics, the use of the carbapenem antibiotics, the use of glycopeptide antibiotics, combined use, the time of use of antibiotics, the indwelling urinary tube, the indwelling gastric tube, the deep vein tube, the tracheal cannula, The distribution of sputum, ventilator, in-vitro drainage, chronic renal failure and neutropenia was statistically significant between the MDRPA and the NMDRPAs (P0.05). The multi-factor analysis showed that the distribution of carbapenem antibiotics and chronic renal failure in the MDRPA group and the NMDRPA group was statistically significant (P0.05). A total of 102 strains of P. aeruginosa were collected from January 1, 2016 to December 31, 2016. The positive rates of mexA, mexB and oprM genes in 102 strains of P. aeruginosa were 65. 7%, 39. 2% and 35. 3% respectively. The high expression of mexA gene was similar to that of P. aeruginosa. The high expression of mexA and mexB was related to the multiple drug resistance of P. aeruginosa.[Conclusion] The resistance rate of P. aeruginosa to each antibiotic is different, and the drug resistance rate of each antibiotic is different from different departments and different age groups. The clinical doctor should reasonably select antibiotics according to the results of the drug sensitivity test. carbapenem antibiotics and chronic renal failure are independent risk factors for multiple drug-resistant Pseudomonas aeruginosa infection. The high expression of mexA gene was involved in the drug resistance of P. aeruginosa to the antibiotic resistance of P. aeruginosa, and the high expression of mexA and mexB gene was involved in the formation of multiple drug resistance of P. aeruginosa.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R446.5

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