目的 探討醫(yī)院獲得性肺炎的銅綠假單胞菌氟喹諾酮耐藥決定域( QRDR) 基因突變及其與臨床用藥的關(guān)系。方法 對(duì)2006 年1 月至2007 年12 月上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院醫(yī)院獲得性肺炎患者痰中分離得到的銅綠假單胞菌84 株, 采用限制性長(zhǎng)度多態(tài)性分析( RFLP) 結(jié)合基因測(cè)序檢測(cè)所得菌株QRDR 的基因突變, 并結(jié)合臨床用藥情況進(jìn)行分析。結(jié)果 50 株耐藥菌經(jīng)檢測(cè)發(fā)現(xiàn)QRDR 區(qū)存在突變42 株, 占84. 0% 。GyrB Ser464 發(fā)生突變34 株, 占68. 0% 。GyrB Ser464 突變組與非突變組比較, 對(duì)應(yīng)的患者分離菌株之前使用β-內(nèi)酰胺類的情況存在差異( OR =11. 3, P = 0. 003及OR=3. 5, P = 0. 023) 。喹諾酮類藥物在采集前30 d 內(nèi)的使用時(shí)間也存在差異( P = 0. 038) 。結(jié)論 銅綠假單胞菌對(duì)喹諾酮的耐藥性與QRDR 區(qū)突變的發(fā)生相一致, 耐藥菌株突變類型以GyrB Ser464突變?yōu)橹? 可能與喹諾酮類和β-內(nèi)酰胺類的使用有關(guān)。
引用本文： 邵萍 ,郭雪君,倪培華,劉瑛. 醫(yī)院獲得性肺炎的銅綠假單胞菌QRDR基因突變分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(6): 539-543. doi: 復(fù)制
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- 1. El-Solh AA, Alhajhusain A. Update on the treatment of Pseudomonas aeruginosa pneumonia. J Antimicrob Chemother, 2009 ,64: 229-238.
- 2. Ray GT, Baxter R, DeLorenze GN. Hospital-level rates of fluoroquinolone use and the risk of hospital-acquired infection with ciprofloxacin-nonsusceptible Pseudomonas aeruginosa, Clin Infect Dis, 2005, 41: 441-449.
- 3. Fluit AC, Visser MR, Schmitz FJ. Molecular Detection of Antimicrobial Resistance. Clin Microbiol Rev, 2001, 14: 836-871.
- 4. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì). 醫(yī)院內(nèi)獲得性支氣管-肺感染診斷標(biāo)準(zhǔn)( 試行草案) . 實(shí)用內(nèi)科雜志, 1990, 10: 540.
- 5. Strateva T, Yordanov D. Pseudomonas aeruginosa--a phenomenon of bacterial resistance. JMed Microbiol, 2009, 58: 1133-1148.
- 6. Sekiguchi JI, Asagi T, Miyoshi-Akiyama T, et al. Outbreaks of Multidrug-Resistant Pseudomonas aeruginosa in Community Hospitals in Japan. J Clin Microbiol, 2007, 45: 979-989.
- 7. Takenouchi T, Sakagawa E, Sugawara M. Detection of gyrA mutations among 335 Pseudomonas aeruginosa strains isolated in Japan and their susceptibilities to fluoroquinolones. Antimicrob Agents chemother, 1999, 43: 406-409.
- 8. Shen LL. Quinolone interactions with DNA and DNA gyrase.Methods Mol Biol, 2001, 95: 171-184.
- 9. MouneimnēH, Robert J, Jarlier V, et al. Type II topoisomerase Mutations in ciprofloxacin-resistant strains of Pseudomonas aeruginosa. Antimicrob Agents Chemother, 1999, 43: 62-66.