| Objective: Analysis of Tianjin Beichen District Hospital PA(Pseudomonas aeruginosa, Pseudomonas aeruginosa) detection of cases and drug resistance, for guiding clinical Pseudomonas aeruginosa infection control, rational use of antimicrobial drugs and anti-bacterial drug resistance reference;In addition, in order to understand the mechanisms of resistance of Pseudomonas aeruginosa hospital, clinical therapy, this paper from the β-lactamase gene encoding types, there are aspects of the situation and the outer membrane protein gene deletion Opr D2 condition were studied.Methods: 1.Samples were collected in hospital patients with a total of 58 strains of Pseudomonas aeruginosa isolated in our hospital, using ATB Expression bacterial identification system of France bio Merieux identification of strain test, drug susceptibility test by bacterial susceptibility of ATB Expression slab, and Kirby Bauer(K-B) method was used in drug sensitivity test.2 using the polymerase chain reaction(polymerase chain, reaction, PCR) resistance related18 Pseudomonas aeruginosa gene detection method.3 of drug resistant Pseudomonas aeruginosa gene PCR amplified product was sequenced,and the sequencing results and the results were compared to the Gen Bank login.Results:1.58 strains of Pseudomonas aeruginosa to ampicillin + Shubatan, cefaclor,cefprozil, cefixime,Cefmetazole, ticarcillin / clavulanic acid, fosfomycin, etimicin,mezlocillin and piperacillin /tazobactam, ceftriaxone, gentamicin, norfloxacin,levofloxacin, aztreonam south, Cefoperazone / Shubatan, imipenem, Amikacin resistance rates were 100%, 95.4%, 95.4%, 94.4%, 94.3%,64.6%, 36.6%, 32.1%,31.1%, 26%, 22.9%, 17.4%, 16.5%, 15.5%, 15.5%, 12.8%, 10%,7.33%.2.58 strains of Pseudomonas aeruginosa in anal lactamase encoding gene TEM,TEM-1, VEB,SHV, GES, PER, OXA-1, OXA-2, OXA-10, CTX-M-1 positive rate were 15.5%,10.3%, 1.7%, 6.8%, 3.4%, 3.4%, 32.7%, 15.5%, 13.7%, 24.1%; metal in beta amidasegene VI M, IMP, SPM, GIM, SIM detection rate is respectively 25.9%,19%, 6.8%, 0%, 0%;plasmid Amp C enzyme gene DHA detection rate is 10.3%;membrane protein Opr D2 genedeletion rate was 48.3%.3.The nucleotide sequence with the Genebank VEB, SHV, TEM, and DHA four genes and thereference gene sequence homology were 100%, no gene mutation phenomenon found.Conclusion: 1.The Court of Pseudomonas aeruginosa resistant to ampicillin +sulbactam highest rate was 100% for ampicillin-resistant Pseudomonas aeruginosa is a natural, even though the addition of sulbactam inhibitors, hospital Statistics resistance rate is still one hundred percent; followed by 95.4% cefaclor, cefprozil was95.4%, 94.4% cefixime, Cefmetazole also reached 94.3%, for the resistance rate of more than 75% of antibacterial drugs should suspend the class of antibacterial drugs in clinical use, according to tracking antimicrobial resistance monitoring results, and then decide whether to resume its clinical application. Resistance rate of more than50% of the antimicrobial agents for ticarcillin / clavulanate 64.6%, susceptibility test results should refer to the use of antibiotics; resistance rate of more than 40% of the antimicrobial agents, should be carefully experience medication; drug resistance rate of more than 30% antimicrobial drugs fosfomycin 36.6%, 32.1% etimicin, Azlocillin31.1%, should be promptly informed of the hospital medical staff warning information; less than 30% of antibacterial drugs piperacillin / tazobactam 26.0%,22.9% ceftriaxone, gentamicin, 17.4%, 16.5%, norfloxacin, aztreonam 15.5%,cefoperazone / sulbactam 12.8%, 10.0%, imipenem, may be more reasonable to become the second-line drug treatment of mixed infections; fluoroquinolone antibiotics norfloxacin resistance rate of 16.5% and 15.5% levofloxacin resistance rates, although resistance rates low, but these drugs, long-term use can also occur if the resistance drugs, so the test is repeated isolates may be necessary; single ring antibiotics representatives aztreonam(15.5%) had anti-PA activity, but weaker, and clinical response ineffective, limited efficacy, only for light, medium the degree of infection; amikacin minimum of 7.33%, is generally not alone for the treatment, but can be used in combination therapy.2.Beta lactamase encoding gene detection rate is relatively high(79%), The positiverate of relatively high gene is: OXA-1(31.9%), VIM(26.1%), CTX-M-1(23.2%);The deletion rate of Membrane protein Opr D2 gene is as high as 48.3%, suggesting that multi drug resistant Pseudomonas aeruginosa to beta lactam antibiotics can be jointly controlled by multi drug resistance gene, mechanism of drug resistance is very complicated with the bacterium.3.The nucleotide sequence with the Genebank DHA, TEM, TEM-1 and PER 4 gene and thereference gene sequence homology were 100%, no gene mutation phenomenon found.4.Infection status and drug resistance of Pseudomonas aeruginosa is not optimistic,should further strengthen the monitoring of molecular epidemiological study on the drug resistance and resistance gene, in this hospital and local infection in treatment decision making more scientific, to prevent the spread of resistant strains, reduce the incidence of nosocomial infections, improve the cure rate of Pseudomonas aeruginosa in clinical infection. |
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