| Background and PurposePA(Pseudomonas aeruginosa)is widely distributed in hospital departments,especially in ICU,respiratory department,burn department and geriatric ward.The bacteria are opportunistic pathogen,usually don′t infect any tissues of the human body.However,when the site of the implant changes or the patient′s own immunity is reduced due to factors such as surgery and chemotherapy,the patient will be infected.PA causes pulmonary infection,sepsis,urinary system infection,traumatic surface infection,etc.In recent years,PA of multi-drugresistance(MDR),extensive drug resistance bacteria(XDR)and even pan-drug resistance(PDR)has emerged,and its drug resistance rate has significantly increased.The reason is largely due to the increasingly serious management negligence and abuse of antibiotics.The medical department is paying attention to solve these problems,Carbapenem antibiotics have a unique trans-conformation which makes them have strong stability and hyperspectral antibacterial activity.They have strongly effect on a variety of bacteria and have high stability to xilin-lactamase,which is one of the best methods for clinical treatment of pseudomonas aeruginosa infection.However not only the resistance of PA strains to carbapenems,but also the drug resistance rate were gradually increased by the excessive and casual use of such antibiotics.There has been no effective medicine for cure the drug-resistant bacteria in clinic.The mechanism of pseudomonas aeruginosa resistance to carbapenems is very complex,among which the most important mechanism is the production of metal β-lacta mase and the lack of channel protein.In view of the studies and reports on the drug resistance of pseudomonas aeruginosa at home and abroad,we designed this subjectto:1.By analyzing the analysis of the drug resistance of pseudomonas aeruginosa in the hospital last two years,the characteristics of drug resistance of pseudomonas aeruginosa in the hospital of traditional Chinese medicine were mastered,and the clinical doctors were instructed to use antibiotics rationally,prevent and control the incidence of nosocomial infection,compared the specimen types,department sources and drug resistance rates by age group.2.Investigatethe type of metal β-lactamase gene and the expression of strain channel protein Opr D2 carried by carbapenem-resistance pseudomonas aeruginosa and preliminarily reveal the drug resistance mechanism of pseudomonas aeruginosa,and the popular drug resistance gene types provide strong laboratory basis for clinical anti-infection treatment.Methods1.Statistical comparisonThe data of pseudomonas aeruginosa of Tai’an City TCM hospital from September2016 to June 2018 were collected and analyzed by WHONET5.6 software.The drug resistance rates of other antibiotics were tested between susceptible strains and resistant strains,and the results were statistically compared with chi-square test.The change of drug resistance rate was compared in six months.2.Phenotype confirmationAfter the collected pseudomonas aeruginosa strain was resuscitated,EDTA double sheet efficiency test was used to screen pseudomonas aeruginosa producing ionosanilase.3.Genetic testingThe amplification products were obtained by using a specific primer sequence and polymerase chain reaction(PCR)to amplify the glutaraldehyde protein genes IMP,VIM and Opr D2.The positive products were sent to ruibiotech biotechnology co.,ltd.for sequencing,and the sequencing results were analyzed by BLAST comparison.ResultStatistical analysis comparisonA total of 204 strains of pseudomonas aeruginosa were detected between September2016 and June 2018.The main source were ICU(30%),respiratory department(18%),cerebral rehabilitation department(17%)and so on.The main source of specimens was sputum,accounting for 89%.The analysis of drug resistance rate was showed that the drug resistance was serious,among which the drug resistance rate of carbapenem sensitive group was different from that of other antibiotic groups.According to the half-year analysis,the drug resistance rate of all kinds of antibiotics is gradually decreasing.There are some differences in the specimen types,department sources and drug resistance rates compared by age group.2.Phenotype confirmationEighty-nine strains of carbapenem-resistance pseudomonas aeruginosa were screened by double slip enhancement test,and 20 metalβ-lactamase positive strains were obtained.3.Genotype detection(1)12 strains of IMP and 0 strain of VIM in the B-type metal chondro-lactamase were amplified from 89 β-carbapenem-resistance pseudomonas aeruginosa.(2)In 89 carbapene-resistant pseudomonas aeruginosa,32 strains of channel protein Opr D2 were amplified,while 57 strains were not amplified with pore protein Opr D2,and the deletion rate of pore protein Opr D2 was 60.1%.(3)The amplified positive gene products were sent out for gene sequencing,and the sequencing results were compared with the gene pool and the anastomosis rate was over97%.Conclusion1.The overall drug resistance rate of pseudomonas aeruginosa to carbapenems is about 35%.Statistical analysis showed that the drug resistance rate of carbapenems was significantly higher in the elderly than in the young.2.The drug resistance rate of cr-pa to all antibiotics is significantly higher than that of cs-pa,and the high detection rate combined with cr-pa should be paid enough attention in clinical practice.3.According to the time group statistical comparison,the drug resistance rate of some antibiotics was significantly reduced after strengthening the management of antibiotics in hospitals.4.20 metal positive strains amplified 12 IMP genes,indicating that the prevalence of metal in this region was mainly IMP genes.5.89 strains of carbapene-resistant pseudomonas aeruginosa were found to have an Oprd2 deletion rate of 60.1%,suggesting that the main mechanism of PA’s isolation on carbapenem resistance in Taian region is closely related to the loss of channel protein Oprd2. |
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