江苏省2016—2021年临床分离铜绿假单胞菌耐药及基因组特征分析

Antimicrobial resistance and genome characteristics of clinically isolated Pseudomonas aeruginosa, Jiangsu Province, 2016-2021

摘要:

目的 了解江苏地区临床分离的铜绿假单胞菌耐药情况及基因特征。 方法 收集2016—2021年江苏地区各哨点医院临床分离的铜绿假单胞菌, 采用肉汤稀释法对分离株进行10类19种抗菌药物的敏感性测定, 对分离株行全基因组测序并多位点序列分型, 综合抗菌药物耐药性数据库(CARD)扫描分析耐药基因。 结果 2016—2021年通过致病菌识别网12个市的哨点医院收集患者分离的铜绿假单胞菌101株。药敏试验结果显示, 全部菌株对共计6类8种抗菌药物全部耐药, 包括酰胺醇类抗生素氯霉素、磺胺类的复方磺胺甲口恶唑、头孢菌素类的头孢噻肟和头孢唑林、四环素类的四环素、青霉素类的氨苄西林及氨苄西林/舒巴坦以及β-内酰胺类的阿莫西林/克拉维酸; 45.54%的分离株为碳青霉烯类耐药菌株, 对亚胺培南、美罗培南两种碳青霉烯类抗生素的耐药率已分别达45.54%、39.60%;耐10种以上抗生素的菌株达63.36%;共发现35种耐药表型, 其中1株菌对19种抗菌药物广泛耐药, 耐药谱为AMC-AM-SAM-CZ-CTX-C-TE-SXT的菌株最多(31.69%, 32株)。多位点序列分析发现75个ST型, 聚类发现ST 262处于中心点, 并遗传进化出11个亚型或分支。全基因组扫描发现6类18种抗菌药物耐药基因, crpP基因的携带情况与表型完全一致。 结论 2016—2021年江苏地区临床分离的铜绿假单胞菌耐药情况严重, 两种碳青霉烯类抗生素的耐药率、耐10种以上抗生素的菌株比例高于国内其他省份, 应引起高度重视。

Abstract:

Objective To understand the antimicrobial resistance and genetic characteristics of clinically isolated Pseudomonas aeruginosa in Jiangsu area. Methods Pseudomonas aeruginosa isolated from sentinel hospitals in Jiangsu area from 2016 to 2021 were collected, susceptibility of bacterial isolates to 19 kinds of 10 categories of antimicrobial agents were detected with broth dilution method. Bacterial strains were performed whole genome sequencing and multilocus sequence typing, antimicrobial resistance genes were scanned and analyzed through comprehensive antimicrobial resistance database. Results From 2016 to 2021, 101 strains of Pseudomonas aeruginosa isolated from patients at sentinel hospitals in 12 cities were collected through the Pathogenic Bacteria Identification Network. Antimicrobial susceptibility testing results showed that all strains were resistant to 8 kinds antimicrobial agents in 6 categories, including chloramphenicol of amphenicols, compound sulfamethoxazole of sulfonamides, cefotaxime and cefazolin of cephalosporins, tetracycline of tetracyclines, ampicillin and ampicillin/sulbactam of penicillins, as well as amoxicillin/clavulanic acid of β-lactams, 45.54% of the isolates were carbapenem-resistant strains. Resistance rates of two carbapenems imipenem and meropenem were 45.54% and 39.60%, respectively, 63.36% of the strains were resistant to more than 10 kinds of antimicrobial agents. A total of 35 kinds of antimicrobial-resistant phenotypes were found, among which one strain was extensively resistant to 19 antimicrobial agents. The most drug-resistant strain was AMC-AM-SAM-CZ-CTX-C-TE-SXT (31.69%, n=32). Multilocus sequence typing analysis revealed 75 ST types, and clustering analysis revealed that ST 262 was at the center point, with 11 subtypes or branches genetically evolved. Whole genome scanning revealed 18 kinds of 6 categories antimicrobial resistance genes, the carrying status and phenotype of the crpP gene were completely consistent. Conclusion From 2016 to 2021, the clinically isolated Pseudomonas aeruginosa in Jiangsu area showed severe antimicrobial resistance, the resistance rates to two carbapenems and the proportion of strains resistant to more than 10 kinds of antimicrobial agents are higher than other provinces in China and should be paid highly attention.