[耐头孢他啶铜绿假单胞菌分离株中β-内酰胺酶的分子流行病学]

[Molecular epidemiology of beta-lactamases in ceftazidime-resistant Pseudomonas aeruginosa isolates].

作者信息

Er Halil, Altındiş Mustafa, Aşık Gülşah, Demir Cengiz

机构信息

Muş State Hospital, Microbiology Laboratory, Muş, Turkey.

出版信息

Mikrobiyol Bul. 2015 Apr;49(2):156-65. doi: 10.5578/mb.8901.

Abstract

Pseudomonas aeruginosa is an important opportunistic pathogen that cause mainly nosocomial infections especially in the immunocompromised patients, the elderly and patients with severe burns. The bacterial feature of developing high degree of resistance against several antibiotics leads to increased morbidity and mortality of P.aeruginosa infections. The aims of this study were to investigate the antibiotic susceptibilities of P.aeruginosa strains isolated from hospitalized patients and to determine the presence of resistance enzymes namely PER, GES, KPC, VIM, IMP and OXA. A total of 195 P.aeruginosa strains isolated from different clinical samples (29 sputum, 67 wound, 53 tracheal aspirate, 23 blood, 18 urine, 3 cerebrospinal fluid, 2 pleural fluid) of inpatients (134 male, 61 female) in Afyon Kocatepe University School of Medicine Hospital between 2010-2012, were included in the study. The isolates were identified by conventional methods and automated systems (VITEK 2, BioMerieux, France), and their antibiotic susceptibilities were detected by disk diffusion and E-test methods. Inducible beta-lactamase (IBL), extended-spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) productions of the isolates were phenotypically investigated by double disk induction, double disk synergy and E-test methods, respectively. The presence of resistance genes encoding PER, GES, KPC, VIM, IMP and OXA enzymes were determined by real-time polymerase chain reaction, and sequence analysis was applied to positive samples. In our study, the antibiotic resistance rates of 195 P.aeruginosa strains were found as follows: ceftazidime 100%, tazobactam/piperacillin 90.8%, aztreonam 60.5%, cefepime 50.2%, imipenem 48.2%, meropenem 47.2%, ofloxacin 47.2%, piperacillin 44.1%, levofloxacin 31.3%, ciprofloxacin 26.2%, gentamicin 11.8%, amikacin 8.7% and tobramycin 6.2%. With the use of phenotypical methods, IBL, ESBL and MBL production rates in the isolates were detected as 89.2% (174/195), 30.7% (60/195) and 26.7% (52/195), respectively. Molecular studies showed that, five strains harboured OXA-10, four OXA-14, four VIM-2, two IMP-1, 26 GES-1 and 87 ABC transporter permease genes, while PER and KPC genes were not detected in any of the isolates. In conclusion, it was considered that the detection of beta-lactamase genes in bacteria and the identification of beta-lactamase types may provide facilities in selection of antibiotics, monitorization of therapy, prevention of resistance development of infection control programs.

摘要

铜绿假单胞菌是一种重要的机会致病菌,主要引起医院感染,尤其是在免疫功能低下的患者、老年人和严重烧伤患者中。该细菌对多种抗生素产生高度耐药的特性导致铜绿假单胞菌感染的发病率和死亡率增加。本研究的目的是调查从住院患者中分离出的铜绿假单胞菌菌株的抗生素敏感性,并确定是否存在耐药酶,即PER、GES、KPC、VIM、IMP和OXA。2010年至2012年期间,从阿菲永科泰佩大学医学院医院住院患者(134名男性,61名女性)的不同临床样本(29份痰液、67份伤口样本、53份气管吸出物、23份血液、18份尿液、3份脑脊液、2份胸水)中分离出的195株铜绿假单胞菌菌株被纳入本研究。通过传统方法和自动化系统(VITEK 2,法国生物梅里埃公司)对分离株进行鉴定,并通过纸片扩散法和E-test法检测其抗生素敏感性。分别采用双纸片诱导法、双纸片协同法和E-test法对分离株的诱导型β-内酰胺酶(IBL)、超广谱β-内酰胺酶(ESBL)和金属β-内酰胺酶(MBL)产生情况进行表型研究。通过实时聚合酶链反应确定编码PER、GES、KPC、VIM、IMP和OXA酶的耐药基因的存在,并对阳性样本进行序列分析。在我们研究中,195株铜绿假单胞菌菌株的抗生素耐药率如下:头孢他啶100%,他唑巴坦/哌拉西林90.8%,氨曲南60.5%,头孢吡肟50.2%,亚胺培南48.2%,美罗培南47.2%,氧氟沙星47.2%,哌拉西林44.1%,左氧氟沙星31.3%,环丙沙星26.2%,庆大霉素11.8%,阿米卡星8.7%,妥布霉素6.2%。采用表型方法检测,分离株中IBL、ESBL和MBL的产生率分别为89.2%(174/195)、30.7%(60/195)和26.7%(52/195)。分子研究表明,五株菌株携带OXA-10,四株携带OXA-14,四株携带VIM-2,两株携带IMP-1,26株携带GES-1和87株携带ABC转运蛋白通透酶基因,而在任何分离株中均未检测到PER和KPC基因。总之,认为检测细菌中的β-内酰胺酶基因并鉴定β-内酰胺酶类型可能有助于抗生素的选择、治疗监测以及预防感染控制计划中耐药性的产生。

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