ICU耐亚胺培南铜绿假单胞菌产金属酶检测及其耐药性分析

目的 了解重症监护病房(ICU)耐亚胺培南铜绿假单胞菌(IRPA)的金属β-内酰胺酶(MBLs)的产生情况及其耐药特性,为临床抗感染治疗提供依据.方法 对深圳市观澜人民医院2010年1月至2011年12月ICU分离的587株铜绿假单胞菌(PAE),用双纸片协同试验检测MBLs产生情况,用VITEK 2 compact全自动微生物分析系统检测其对17种抗生素的耐药性.结果 在587株PAE中,IRPA 127株,占21.6％；IRPA对其中7种抗生素为全耐药,对其余10种抗生素的耐药率也在40％以上；IRPA组及亚胺培南敏感铜绿假单胞菌(ISPA)组两组间对常用抗生素的耐药率比较,除AMP、CZO、FTN、SXT、SAM及CTT外,两组其余抗生素的耐药率差异均有统计学意义(P＜0.01)；在127株IRPA中,产MBLs 45株,产酶率为35.4％.结论 IRPA的检出率较高,多药耐药现象较严重,产MBLs是PAE对IPM及头孢类抗菌药物耐药的主要原因之一,应参考实验室的药敏结果,合理选用抗菌药物.

Metalloenzyme detection and drug resistance analysis on imipenem-resistant Pseudomonas aeruginosa from ICU

Objective To understand metallo-beta-lactamese(MBLs) generation and drug resistance of the imipenem-resistant Pseudomonas aeruginosa(IRPA) from intensive care unit(ICU),provide evidences for clinical anti-infection treatment.Method 587 strains of Pseudomonas aeruginosa(PAE) isolated from the ICU of the hospital between January 2010 to December 2011 were detected MBLs by using double disk synergy test;VITEK 2 compact automatic microbiology analysis system was used to detect their resistance to 17 antibiotics.Result In the 587 strains of PAE,127 strains of IRPA were detected(21.6%);The resistance rate of these IRPA strains was 100% to 7 antibiotics and over 40% to the remaining 10 antibiotics;There was significant difference between the resistances of IRPA and imipenem-sensitive Pseudomonas aeruginosa(ISPA) to common antibiotics except to AMP,CZO,FTN,SXT,SAM and CTT(P<0.01);Of the 127 strains of IRPA,45 strains were MBLs(35.4%).Conclusion The detection rate of IRPA is high,with severe multidrug resistance.MBLs production is one of the main causes of the resistance of PAE to IPM and cephalosporin antibiotics.Laboratory susceptibility results should be taken into account for reasonable choice of antibacterial drugs.