■耐碳青霉烯类铜绿假单胞菌(CRPA)是一个日益严重的威胁。迫切需要了解CRPA的多药耐药性和高毒力,为感染控制和合理使用抗生素提供依据。
■对56个非重复CRPA分离株进行了回顾性研究。
■CRPA主要来自重症监护病房(ICU),大部分从痰标本中分离出来。铜绿假单胞菌碳青霉烯类耐药率为21.37%(2016年),2016年至2020年分别为10.62%、5.88%、10%和13.87%。在所有分离物中检测到碳青霉烯耐药酶和氨基糖苷修饰酶编码基因,和广谱β-内酰胺酶和头孢菌素酶编码基因在96.43和80.38%的分离株中存在,分别。OprM的检出率在ICU与其他病房间差异有统计学意义(p<0.05)。与生物膜相关的基因,膜通道蛋白,在所有分离物中检测到I整合子和外排系统,检出率大于90%。CRPA有很强的毒性,超过80%的分离株携带高毒力相关基因(exoU,exoS,exoT,和exoY)。头孢吡肟和哌拉西林/他唑巴坦的耐药率在exoU(+)和exoU(-)菌株间差异有统计学意义(p<0.05)。值得注意的是,在死亡的7个人中,4例铜绿假单胞菌广泛耐药(57.14%)。
■各种抗性和毒力基因的检出率高,共存现象严重。在临床实践中,应根据不同的耐药基因合理使用抗生素,以确保患者用药的合理性和安全性。
UNASSIGNED: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a growing threat. It is urgent to investigate the multidrug resistance and high virulence of CRPA to provide a basis for infection control and rational use of antibiotics.
UNASSIGNED: A retrospective study of 56 nonduplicated CRPA isolates was conducted.
UNASSIGNED: CRPA mainly came from the intensive care unit (ICU) and was mostly isolated from sputum samples. The carbapenem resistance rates of P. aeruginosa were 21.37% (2016), 10.62, 5.88, 10 and 13.87% from 2016 to 2020, respectively. Carbapenem-resistant enzymes and aminoglycoside-modifying enzyme-encoding genes were detected in all isolates, and extended-spectrum β-lactamase and cephalosporin enzyme-encoding genes were present in 96.43 and 80.38% of isolates, respectively. The detection rate of OprM showed a statistically significant difference (p < 0.05) between the ICU and other wards. Genes related to biofilms, membrane channel proteins, I integrons and efflux systems were detected in all isolates, with detection rates greater than 90%. CRPA was strongly virulent, and over 80% of isolates carried hypervirulence-associated genes (exoU, exoS, exoT, and exoY). The drug resistance rates of cefepime and piperacillin/tazobactam showed a statistically significant difference (p < 0.05) between strains with exoU (+) and exoU (-) (p < 0.05). Notably, out of the 7 individuals who died, 4 had extensively drug-resistant P. aeruginosa (57.14%).
UNASSIGNED: The detection rates of various resistance and virulence genes were high, and the coexistence phenomenon was serious. In clinical practice, antibiotics should be used reasonably based on different drug resistance genes to ensure the rationality and safety of patient medication.