多重耐药鲍曼不动杆菌β-内酰胺酶分析  

Nosocomial infections of acinetobacter Baumanii producing carbapenemase and extended-spectrum beta-lactamases

作　　者：倪群[1] 黄回[2] 杨青[3] 林洁[4] 俞云松[3] 季峰[3] 

机构地区：[1]浙江大学校医院,310027 [2]浙江大学医学院 [3]浙江大学医学院附属第一医院 [4]浙江大学医学院附属邵逸夫医院

出　　处：《浙江医学》2005年第10期730-732,共3页Zhejiang Medical Journal

基　　金：浙江省科技计划资助项目(021103017)

摘　　要：目的分析临床分离的4株亚胺培南耐药鲍曼不动杆菌的同源性及β-内酰胺酶。方法采用浓度梯度法(Etest)测定亚胺培南等12种抗菌药物对4株菌株的最低抑菌浓度(MIC),脉冲场凝胶电泳(PFGE)分析菌株间的同源性,等电点聚焦电泳(IEF)、三维试验、2-巯基丙酸抑制试验、聚合酶链反应(PCR)及克隆测序等方法分析β-内酰胺酶。结果4株亚胺培南耐药鲍曼不动杆菌来自同一克隆株,耐药谱基本一致,仅1株对头孢吡肟、头孢哌酮/舒巴坦中度敏感,对其余抗菌药物均高度耐药。三维试验显示4株细菌存在能水解亚胺培南的酶。3株细菌有pI5.4、5.8、6.6、7.2条带,另1株少pI5.8条带,pI5.4、5.8条带均能被克拉维酸抑制。PCR扩增产物经克隆测序证实同时存在OXA-23、PER-1基因。结论存在同时产OXA-23型碳青霉烯酶和PER-1型超广谱β-内酰胺酶的鲍曼不动杆菌引起的医院感染。Objective To analyze beta-lactamases produced by 4 imipenem-resistant Acinetobacter baumanii strains isolated in general surgery unit. Methods E test was used to determine the minimal inhibitory concentration （MIC） of these strains, and the homology was analyzed hy pulsed-field gel electrophoresis （PFGE）; the beta-lactamases produced by these strains were typed by isoelectfic focusing （IEF） electrophoresis, threedimensional test, 2-mercaptopropanoic acid inhibited assays, polymerase chain reaction （PCR）, cloning and sequencing. Results Only one strain was intermediately resistant to cefoperazone/sulbactam and cefepime, and remaining strains were highly resistant to other antibiotics tested. PFGE pattern of 4 strains was identical. One strain had 3 bands on IEF electrophoresis, the pls of which were 5.4, 6.6 and 7.2 respectively. The others had 4 bands with pI of 5.4, 5.8, 6.6 and 7.2, the bands with pls of 5,40 and 5.8 were inhibited by clavulanic acid. PCR products were sequenced and revealed that all strains harbored a blaOXA-23 and a blaPER-1 gene. Conclusion The nosocomial infection in general surgery unit was caused by A. baumanii which produces OXA-23 type carbapenemase and PER-1 type extended-spectrum beta-lactamases.

关 键 词：多重耐药性 鲍曼不动杆菌 Β-内酰胺酶 抗菌药物 医院感染 

分 类 号：R446.5[医药卫生—诊断学]