宋敏，向成玉，丁银环，杨葵，吴泽才，林雁，刘靳波（西南医科大学附属医院检验科，四川泸州646000）

·论著·

多药耐药铜绿假单胞菌耐药表型及分子流行病学调查研究*

宋敏，向成玉，丁银环，杨葵，吴泽才，林雁，刘靳波△
（西南医科大学附属医院检验科，四川泸州646000）

目的探讨该院多药耐药铜绿假单胞菌（PAE）的耐药表型及其分子流行病学特征，为医院内感染监控和制订感染控制措施提供科学依据。方法收集该院2012年9月至2013年2月临床分离的49株多药耐药PAE，采用MicroScan WalkAway 96SI全自动微生物鉴定/药敏测试系统鉴定菌株并获得对15种抗菌药物药敏结果。利用基因外重复回文序列-聚合酶链反应（REP-PCR）对PAE进行分子分型。结果49株多药耐药PAE，对亚胺培南的耐药率最高，为79.6%；对庆大霉素、阿米卡星、妥布霉素、头孢他啶、头孢曲松钠、头孢噻肟、头孢吡肟、氨曲南、加替沙星、环丙沙星、左氧氟沙星、哌拉西林、哌拉西林/甲巯咪唑、替卡西林/克拉维酸的耐药率在38.8%～65.3%。49株PAE的遗传相似性为0.70～1.00，经REP-PCR技术，将49株多药耐药PAE分为4型及9个亚型。结论该院多药耐药PAE耐药严重并存在克隆传播流行，及时实施医院内感染的防控策略，能有效预防多药耐药PAE的暴发和流行。

假单胞菌，铜绿；聚合酶链反应；药物耐受性；交叉感染

【Abstract】Objective To investigate the drug resistance phenotype andmoleculare pidemiology characteristics of multidrug resistant pseudomonas aeruginosa（PAE）to provide the scientific basis for controlling the nosocomial infection and formulating the infection controlmea sures.Methods Forty-nine strains of multi-drug resistantPAE in our hospital from September 2012 to February 2013 were collected and identified by the Micro Scan Walk Away 96 SIautomaticmicrobial identification/susceptibility testsystem.The susceptibility results of PAE to 15 kinds ofantibacterial drugswere obtained at the same time.Finally，PAE was performed the molecular typing by repetitive extragenic palindromic-polymerase chain reaction（REP-PCR）.Results Forty-nine strains of multi-drug resistant PAE had the highest resistance to imipenem（79.6%）；which to gentamicin，amikacin，tobramycin，ceftazidime，ceftriaxone，cefotaxime，cefepime，aztreonam，gatifloxacin，cipr of loxacin，lev of loxacin，piperacillin，piperacillin/me thimazole，ticarcillin/clavulanate was 38.8%-65.3%.Forty-nine isolates of PAE had the genetic similarity of0.70-1.00 and were divided into 4 typesand 9 subtypesby using REP-PCR.Conclusion Multi-drug resistantPAE has serious drug-resistance and the cloned spread exists in our hospital，the timely implementation of hospital infection prevention and control strategies can effectively prevent the outbreaksand prevalence of multi-drug resistant PAE.

【Key words】Pseudomonasaeruginosa；Polymerase chain reaction；Drug tolerance；Cross infection

铜绿假单胞菌（PAE）是引起人类感染的常见条件致病菌之一，可引起皮肤、黏膜、胃肠道、呼吸道等部位的感染，在医院内感染中占了重要地位。2011年卫生部全国细菌耐药监测网统计显示，PAE临床分离率在非发酵菌中位居第一［1］。……