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目的分析肝癌术后患者医院感染嗜麦芽寡养单胞菌耐药性及耐药基因分布,为有效防治嗜麦芽寡养单胞菌医院感染发生提供参考。方法收集1 253例肝癌患者术后痰液、咽拭子等标本,分离嗜麦芽寡养单胞菌,经鉴定后采用K-B法进行耐药性分析。制备细菌的PCR模板液,并设计和合成引物,采用PCR扩增耐药基因,分析耐药基因分布情况。结果肝癌患者术后感染共分离出173株嗜麦芽寡养单胞菌,且主要来自于痰液、腹腔引流液及咽拭子标本。药敏结果显示,分离株嗜麦芽寡养单胞菌对庆大霉素、妥布霉素、阿米卡星、头孢吡肟、头孢曲松、亚胺培南、磺胺甲恶唑/甲氧苄啶的耐药率分别为95.36%、89.60%、85.55%、87.86%、88.44%、63.01%和74.57%。PCR扩增嗜麦芽寡养单胞菌,且aac(3)-Ⅱ、aac(6′)-Ⅱ、ant(2“)-Ⅰ、L1、L2、sul1、sul2的7种耐药基因大小分别为237、178、320、780、900、581和657bp,其中在庆大霉素、妥布霉素、阿米卡星耐药株中检测到aac(3)-Ⅱ、aac(6′)-Ⅱ和ant(2”)-Ⅰ基因,在头孢吡肟、头孢曲松耐药株中检测到L1和L2基因,在磺胺甲恶唑/甲氧苄啶耐药株中均检测到sul1基因sul2基因,在亚胺培南嗜麦芽寡养单胞菌耐药株中检测到L1、L2、aac(6′)-Ⅱ和sul1基因,可能是产生了多药耐药株。结论肝癌患者术后医院感染嗜麦芽寡养单胞菌对多种抗菌药物耐药,其耐药性的产生与携带相应耐药基因相关。
Objective To analyze the drug resistance and drug resistance gene distribution of Nosocomial Stenotrophomonas maltophilia in patients with postoperative hepatocellular carcinoma (HCC), and to provide references for the effective prevention and treatment of Stenotrophomonas maltophilia. Methods Totally 1 253 cases of hepatocellular carcinoma patients were collected sputum and throat swabs, and Stenotrophomonas maltophilia was isolated. K-B method was used to analyze the drug resistance. The bacterial template PCR solution was prepared, and the primers were designed and synthesized. The resistance genes were amplified by PCR and the distribution of drug resistance genes was analyzed. Results Totally 173 strains of Stenotrophomonas maltophilia were isolated from postoperative infection in patients with hepatocellular carcinoma, mainly from sputum, peritoneal drainage and throat swab specimens. Susceptibility results showed that the isolates Stenotrophomonas maltophilia on gentamicin, tobramycin, amikacin, cefepime, ceftriaxone, imipenem, sulfamethoxazole / methoxy The rates of resistance to benzylamine were 95.36%, 89.60%, 85.55%, 87.86%, 88.44%, 63.01% and 74.57%, respectively. PCR amplification of Stenotrophomonas maltophilia and analysis of 7 resistance gene sizes of aac (3) -Ⅱ, aac (6 ’) - Ⅱ, ant (2 ") - Ⅰ, L1, Aac (3) -Ⅱ, aac (6 ’) were detected in gentamicin, tobramycin and amikacin-resistant strains, L1 gene and L2 gene were detected in cefepime and ceftriaxone resistant strains, and sul1 was detected in both sulfamethoxazole / trimethoprim resistant strains Genes sul2 gene was detected in the imipenem Stenotrophomonas maltophilia strains L1, L2, aac (6 ’) - Ⅱ and sul1 gene may be multidrug resistant strains. Conclusion The postoperative nosocomial infection of Stenotrophomonas maltophilia is resistant to many antimicrobial agents, and its drug resistance is associated with carrying the corresponding drug resistance genes.