目的：探讨院内普通外科分离的铜绿假单胞菌的基因同源性及Ⅲ型分泌系统(TTSS)的毒力基因的临床意义。方法采用纸片扩散法(KB法)及微量肉汤稀释法检测2009年12月~2014年9月广州医科大学附属第四医院普通外科临床分离的102株铜绿假单胞菌对常用的13种抗菌药物的最低抑菌浓度(MIC)。采用脉冲场凝胶电泳(PFGE)技术对耐碳青霉烯类铜绿假单胞菌进行基因分型及毒力基因筛查，同时采用PCR调查毒力基因exo U、exo S在耐碳青霉烯类铜绿假单胞菌中的发生率。结果102株铜绿假单胞菌对临床常用的13种抗菌药物耐药率均低于30%，对阿米卡星的耐药率最低(9.8%)，对亚胺培南的耐药率为23.5%，对美罗培南的耐药率为18.6%。24株耐碳青霉烯类铜绿假单胞菌PCR检测显示均携带TTSS，其中3株exo U+/exo S-，21株exo U-/exo S+；PFGE分型主要为A、B、C、D、E、F共6型，其中A型为主要流行株。回顾性分析表明，exo U+/exo S-型患者临床特征是多有气管插管史、ICU住院史、抗感染治疗多采用联合用药，以铜绿假单胞菌感染居多；exo U-/exo S+患者的临床特征是多存在肺部基础疾病，预后好于exo U+/exo S-型患者，以铜绿假单胞菌定植居多。结论耐碳青霉烯类铜绿假单胞菌在普通外科存在流行趋势，应加强铜绿假单胞菌耐药监测，防止耐药菌的暴发流行。%Objective To investigate the general surgery of Pseudomonas aeruginosa nosocomial gene homology and type Ⅲ secretion system (TTSS) virulence genes of clinical significance. Methods 102 strains of pseudomonas aerugi-nosa isolated from December 2009 to September 2014 in Department of General Surgery, the Fourth Affiliated Hospital of Guangzhou Medical University, the minimal inhibitory concentration of those Pseudomonas aeruginosa to 13 kinds of commonly used antibiotics were detected by the method of disc diffusion and trace the broth dilution. Genotyping and virulence gene screening of Penicillium carbon alkene resistant Pseudomonas aeruginosa were carried by pulsed field gel electrophoresis (PFGE) technology, at the same time incidence rate of virulence genes exo U and exo S in carbapen-em resistant Pseudomonas aeruginosa was investigated by PCR. Results 102 strains of Pseudomonas aeruginosa to clin-ical commonly used 13 kinds of antimicrobial resistance were less than 30%, the lowest prevalence of Amikacin resis-tance (9.8%), resistant rate to Imipenem were 23.5%, resistant rate to Meropenem were 18.6%. 24 strains Penicillium resistant to carbon alkene detect Pseudomonas aeruginosa PCR showed all carry TTSS, three strains exo U+/exo S-, 21 strains exo U-/exo S+; types of PFGE were A, B, C, D, E, F, a total of 6 types, and type A was the main epidemic strains. Retrospective analysis showed that, clinical characteristics of patients with exo U+/exo S-type was more histo-ries of endotracheal intubation and ICU admission, anti-infection treatment with combination, in the majority with Pseudomonas aeruginosa infection. clinical features of patients with exo U-/exo S+ was many patients existed pul-monary diseases, the prognosis of patients with exo U-/exo S+ was better than that of patients with exo U+/exo S-, in the majority with Pseudomonas aeruginosa engraftment. Conclusion Carbapenem-resistant Pseudomonas aeruginosa in general surgery are popular trend, Pseudomonas aeruginosa resistance monitoring should be strengthened, to prevent the epidemic of drug-resistant bacteria.
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