对亚胺培南耐药的鲍曼不动杆菌同源性及碳青霉烯酶基因型研究  

Study on the homology and carbapenemases genotypes of imipenem-resistant Acinetobacter baumannii strains

作　　者：朱冰泉[1] 沈萍[2] 俞云松[2] 张幸国[3] 

机构地区：[1]浙江大学医学院附属儿童医院内科,杭州310003 [2]浙江大学医学院附属第一医院传染科 [3]浙江大学医学院附属第一医院药剂科

出　　处：《浙江医学》2008年第5期459-462,共4页Zhejiang Medical Journal

基　　金：国家科技部863计划(2006AA02Z413);省部共建项目(WKJ2005-2-409)

摘　　要：目的探讨我省11个地区20家医院临床分离的对亚胺培南耐药的鲍曼不动杆菌耐药性、同源性和碳青霉烯酶基因型。方法收集我省11个地区20家医院2004年12月至2005年12月临床分离的271株对亚胺培南耐药的鲍曼不动杆菌。采用琼脂稀释法和浓度梯度法(Etest)测定亚胺培南耐药菌株对14种抗菌药物的最低抑菌浓度(MIC)值;采用脉冲场凝胶电泳法(PFGE)分析亚胺培南耐药菌株的同源性;采用PCR扩增及克隆测序分析碳青霉烯酶基因型。结果271株对亚胺培南耐药的鲍曼不动杆菌对多黏菌素E耐药率最低(11.8%),头孢哌酮/舒巴坦、氨苄西林/舒巴坦耐药率分别为55.4%和68.6%,米诺环素耐药率75.6%,其余抗菌药物耐药率均大于90.0%;PFGE分型发现271株对亚胺培南耐药的鲍曼不动杆菌中235株属于3个克隆株,在多个城市的医院内流行,另有13株属于2个克隆株,分别在一个城市的医院内播散;271株对亚胺培南耐药的鲍曼不动杆菌均携带OXA-51组基因,258株携带OXA-23组基因,未检测到金属酶基因。结论克隆播散是对亚胺培南耐药的鲍曼不动杆菌最主要的传播方式,OXA-23和OXA-66D类β-内酰胺酶基因是最主要的碳青霉烯酶基因型。Objective To identify the antibiotic resistance, homology and the carbapenemases genotypes of imipenem-resistant strains of Acinetobacter baumannii isolated from Zhejiang Province. Methods Two hundred and seventy one imipenem-resistant strains of Acinetobacter baumanii were isolated from 11 cities of Zhejiang province through Dec 2004 to Dec 2005. The MICs of imipenem-resistant strains to 14 antimicrobial agents were determined by agar dilution and Etest method. The homology of these isolates was analyzed by pulse-field gel electrophoresis （PFGE）. The genotypes of carbapenamases were determined by PCR and DNA sequencing. Results The resistant rates of 271 isolates of Acinetobacer baumannii to ampicillin/sulbactam and cefoperazone/sulbactam were 68.6% and 55.4%, respectively; The resistance rate to polymyxin E was only 11.8% and that to minocycline was 75.6%. The resistant rates to other antimicrobial agents were more than 90%. Two hundred and ninety-eight of 342 strains of carbapenem resistant Acinetobacter baumannii were identified as 6 epidemic PFGE-clones. All 271 imipenem resistant isolates contained OXA-51-tike carbapenemase gene and 258 isolates were positive for OXA-23 gene. Conclusion All imipenem-resistant isolates of Acinetobacer baumannii in this study were pan-resistant strains. Clone dissemination seems to be the most important way of strains spread. OXA-23-like and OXA-51-like gene are the most popular carbapenemases coding genes in imipenem-resistant Acinetobacter baumannii in Zhejiang Province.

关 键 词：鲍曼不动杆菌 耐药性 脉冲场凝胶电泳 碳青霉烯酶 

分 类 号：R450[医药卫生—治疗学]