耐多药铜绿假单胞菌感染临床特征及耐药机制分析
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摘要
目的分析耐多药铜绿假单胞菌感染临床特征及耐药机制,指导临床抗感染治疗。方法收集344例医院患者临床资料,分离鉴定病原菌,分析铜绿假单胞菌耐药性,观察耐多药菌株形态。结果 172株耐多药铜绿假单胞菌中,分离自深部痰、中段尿、血液、伤口、创面以及其他标本分别为84、28、23、19、14和4株,构成比分别为48.84%、16.28%、13.37%、11.05%、8.14%和2.33%。ICU、神经外科、老年病科、呼吸内科、神经内科、骨外科、普通外科、泌尿外科及其他科室分别分离71、40、19、14、10、5、3、3和7株,构成比分别为41.28%、23.26%、11.05%、8.14%、5.81%、2.91%、1.74%、1.74%和4.07%。疾病类型、采用血液透析、糖皮质激素、免疫抑制剂使用不同患者耐多药铜绿假单胞菌感染差异无统计学意义。机械通气和手术治疗是耐多药铜绿假单胞菌感染的影响因素。扫描电镜示,耐多药菌株周围有类絮状基质物质等典型生物被膜结构。透射电镜观察可清晰观察到菌体周围的生物被膜结构。结论耐多药铜绿假单胞菌主要分离自痰液样本,ICU是主要检出科室,机械通气和手术治疗是感染发生的影响因素,多耐药铜绿假单胞菌有典型的生物膜结构。
Objective To analyze the clinical features and the mechanism of drug resistance of multidrug-resistant Pseudomonas aeruginosain order to guide clinical treatment of those infections. Methods Clinical data on 344 inpatients were collected to isolate and identify pathogenic bacteria.The drug resistance of P.aeruginosa was analyzed,and the morphology of multidrug-resistant P.aeruginosa strains was observed. Results One hundred and seventy-two strains of multidrug resistant P.aeruginosa were isolated.Of these,84 strains(48.84%)were isolated from deeply lodged phlegm,28(16.28%)were isolated from mid-stream urine,23(13.37%)were isolated from blood,19(11.05%)were isolated from wounds,14(8.14%)were isolated from a wound surface,and 4(2.33%)were isolated from other specimens.Seventy-one strains(41.28%)were isolated from the ICU,40(23.26%)were isolated from Neurosurgery,19(11.05%)were isolated from Geriatrics,14(8.14%)were isolated from Respiratory Medicine,10(5.81%)were isolated from Neurology,5(2.91%)were isolated from Orthopedics,3(1.74%)were isolated from General Surgery,3(1.74%)were isolated from Urology,and 7(4.07%)were isolated from other departments.An analysis of factors for infection with multidrug-resistant P.aeruginosarevealed no significant difference in the type of illness,being on hemodialysis,or receiving glucocorticoids or immunosuppressive agents in patients who were infected with multidrug-resistant P.aeruginosaand patients who were not infected.However,being on mechanical ventilation and undergoing surgery affected infection with multidrug-resistant P.aeruginosa.Observation of bacterial morphology and the biofilm structure with SEM indicated that multidrug-resistant P.aeruginosastrains have cells surrounded by a type of cloud-like matrix,i.e.a typical biofilm structure.The biocapsule structure around the bacteria was readily evident in TEM. Conclusion Multidrug-resistant P.aeruginosa was mainly isolated from sputum samples,and strains were mainly detected in the ICU.Being on mechanical ventilation and undergoing surgery were the main factors for development of an infection.The formation of a biofilm structure is the main mechanism by which P.aeruginosadevelops multidrug resistance.
Objective To analyze the clinical features and the mechanism of drug resistance of multidrug-resistant Pseudomonas aeruginosain order to guide clinical treatment of those infections. Methods Clinical data on 344 inpatients were collected to isolate and identify pathogenic bacteria.The drug resistance of P.aeruginosa was analyzed,and the morphology of multidrug-resistant P.aeruginosa strains was observed. Results One hundred and seventy-two strains of multidrug resistant P.aeruginosa were isolated.Of these,84 strains(48.84%)were isolated from deeply lodged phlegm,28(16.28%)were isolated from mid-stream urine,23(13.37%)were isolated from blood,19(11.05%)were isolated from wounds,14(8.14%)were isolated from a wound surface,and 4(2.33%)were isolated from other specimens.Seventy-one strains(41.28%)were isolated from the ICU,40(23.26%)were isolated from Neurosurgery,19(11.05%)were isolated from Geriatrics,14(8.14%)were isolated from Respiratory Medicine,10(5.81%)were isolated from Neurology,5(2.91%)were isolated from Orthopedics,3(1.74%)were isolated from General Surgery,3(1.74%)were isolated from Urology,and 7(4.07%)were isolated from other departments.An analysis of factors for infection with multidrug-resistant P.aeruginosarevealed no significant difference in the type of illness,being on hemodialysis,or receiving glucocorticoids or immunosuppressive agents in patients who were infected with multidrug-resistant P.aeruginosaand patients who were not infected.However,being on mechanical ventilation and undergoing surgery affected infection with multidrug-resistant P.aeruginosa.Observation of bacterial morphology and the biofilm structure with SEM indicated that multidrug-resistant P.aeruginosastrains have cells surrounded by a type of cloud-like matrix,i.e.a typical biofilm structure.The biocapsule structure around the bacteria was readily evident in TEM. Conclusion Multidrug-resistant P.aeruginosa was mainly isolated from sputum samples,and strains were mainly detected in the ICU.Being on mechanical ventilation and undergoing surgery were the main factors for development of an infection.The formation of a biofilm structure is the main mechanism by which P.aeruginosadevelops multidrug resistance.
引文
[1] 凌月明,陈金玉,刘秀华,等.多药耐药铜绿假单胞菌耐药机制与菌株亲缘性分析[J].中华医院感染学杂志,2009,19(23):3168-71.
[2] Bennett PM.Plasmid encoded antibiotic resistance:acquisition andtransfer of antibiotic resistance genes in bacteria[J].Br J Pharma-col,2008(153):S347-S357.
[3] Ochman H,Lawrence JG,Groisman EA.Lateral gene transferand the nature of bacterial innovation[J].Nature,2000,405(5):299-304.
[4] Saitou K,Furuhata K,Kawakami Y,et al.Biofilm formation a-bilities and disinfectant-resistance of Pseudomonas aeruginosaiso-lated from cockroaches captured in hospitals[J].Biocontrol Sci,2009,14(2):65-8.
[5] 彭定辉,周铁丽,朱丽青,等.铜绿假单胞菌临床感染及耐药特性分析[J].中华医院感染学杂志,2009(19):111-3.
[6] 吴兆勇,周军纯,赖雄,等.院内感染铜绿假单胞菌的耐药趋势分析[J].中国热带医学,2009,9(12):2294-6.
[7] Liguori G,Bagattini M,Gall F,et al.Microbiological evaluationof the efficacy of two new biodetergents on multidrug-resistantnosocomial pathogen[J].Ann Clin Microbiol Antimicrob,2009(8):35-41.
[8] Broomfield RJ,Morgan SD,Khan A,et al.Crystalline bacterialbiofilm formation on urinary catheters by urease-producing urinarytract pathogens:a simple method of control[J].J Med Microbiol,2009,58(10):1367-75.
[9] 王静,李端,徐德忠.多重耐药铜绿假单胞菌院内感染的危险因素及药物敏感分析[J].中国现代医学杂志,2009,19(1):126-8.
[10] 李九龙,郭嘉义,张燕,等.铜绿假单胞菌PA0861突变菌株表达谱检测分析[J].中国病原生物学杂志,2017,12(6):495-9,504.
[11] 文细毛,任南,吴安华,等.864例次耐压安培南铜绿假单胞菌医院感染特征分析[J].中国医院感染学杂志,2010,20(16):2416-8.
[12] Rodrigues LB,Dos Santos LR,Tagliari VZ,et al.Quantification of biofilm production on polystyrene by Listeria,Escherichia coli and Staphylococcus aureus isolated from a poultry slaughterhouse[J].Braz J Microbiol,2010,41(4):1082-5.
[13] 魏树全,赵子龙,钟维农,等.泛耐药铜绿假单胞菌肺炎危险因素的病例对照研究[J].中国医院感染学杂志,2009,19(6):673-6.
[14] Kwiatek M,Mizak L,Parasion S,et al.Characterization of five newly isolated bacteriophages active against Pseudomonas aeruginosa clinical strains[J].Folia Microbiol(Praha),2015,60(1):7-14.
[2] Bennett PM.Plasmid encoded antibiotic resistance:acquisition andtransfer of antibiotic resistance genes in bacteria[J].Br J Pharma-col,2008(153):S347-S357.
[3] Ochman H,Lawrence JG,Groisman EA.Lateral gene transferand the nature of bacterial innovation[J].Nature,2000,405(5):299-304.
[4] Saitou K,Furuhata K,Kawakami Y,et al.Biofilm formation a-bilities and disinfectant-resistance of Pseudomonas aeruginosaiso-lated from cockroaches captured in hospitals[J].Biocontrol Sci,2009,14(2):65-8.
[5] 彭定辉,周铁丽,朱丽青,等.铜绿假单胞菌临床感染及耐药特性分析[J].中华医院感染学杂志,2009(19):111-3.
[6] 吴兆勇,周军纯,赖雄,等.院内感染铜绿假单胞菌的耐药趋势分析[J].中国热带医学,2009,9(12):2294-6.
[7] Liguori G,Bagattini M,Gall F,et al.Microbiological evaluationof the efficacy of two new biodetergents on multidrug-resistantnosocomial pathogen[J].Ann Clin Microbiol Antimicrob,2009(8):35-41.
[8] Broomfield RJ,Morgan SD,Khan A,et al.Crystalline bacterialbiofilm formation on urinary catheters by urease-producing urinarytract pathogens:a simple method of control[J].J Med Microbiol,2009,58(10):1367-75.
[9] 王静,李端,徐德忠.多重耐药铜绿假单胞菌院内感染的危险因素及药物敏感分析[J].中国现代医学杂志,2009,19(1):126-8.
[10] 李九龙,郭嘉义,张燕,等.铜绿假单胞菌PA0861突变菌株表达谱检测分析[J].中国病原生物学杂志,2017,12(6):495-9,504.
[11] 文细毛,任南,吴安华,等.864例次耐压安培南铜绿假单胞菌医院感染特征分析[J].中国医院感染学杂志,2010,20(16):2416-8.
[12] Rodrigues LB,Dos Santos LR,Tagliari VZ,et al.Quantification of biofilm production on polystyrene by Listeria,Escherichia coli and Staphylococcus aureus isolated from a poultry slaughterhouse[J].Braz J Microbiol,2010,41(4):1082-5.
[13] 魏树全,赵子龙,钟维农,等.泛耐药铜绿假单胞菌肺炎危险因素的病例对照研究[J].中国医院感染学杂志,2009,19(6):673-6.
[14] Kwiatek M,Mizak L,Parasion S,et al.Characterization of five newly isolated bacteriophages active against Pseudomonas aeruginosa clinical strains[J].Folia Microbiol(Praha),2015,60(1):7-14.