老年患者耐亚胺培南鲍氏不动杆菌研究  

Imipenem-resistant Acinetobacter baumannii in Elderly Patients

作　　者：肖震[1] 周华[2] 李良红[3] 魏泽庆[2] 俞云松[2] 

机构地区：[1]浙江医院检验科,浙江杭州310013 [2]浙江大学医学院附属第一医院传染科实验室,浙江杭州310003 [3]南京军区杭州疗养院,浙江杭州310007

出　　处：《中华医院感染学杂志》2009年第10期1171-1174,共4页Chinese Journal of Nosocomiology

摘　　要：目的明确医院临床分离老年患者耐亚胺培南鲍氏不动杆菌的耐药性、同源性、碳青酶烯酶基因型及其基因周围环境。方法收集医院2005年1月-2007年1月临床分离的142株鲍氏不动杆菌,纸片扩散法筛选耐亚胺培南鲍氏不动杆菌;琼脂稀释法测定亚胺培南耐药菌株对14种抗菌药物的MIC值;脉冲场凝胶电泳(PFGE)分析亚胺培南耐药菌株同源性;PCR扩增及克隆测序分析碳青酶烯酶基因及其周围基因环境。结果142株鲍氏不动杆菌中筛选到97株耐亚胺培南鲍氏不动杆菌;PFGE分型中全部菌株属于4个流行的克隆株;97株耐亚胺培南鲍氏不动杆菌中90株携带OXA-23-like基因,97株携带OXA-51-like基因,86株菌株OXA-23-like基因上游检测到插入序列ISAba1,6株OXA-51基因上游检测到ISAba1。结论所有耐亚胺培南鲍氏不动杆菌均为泛耐药菌,克隆播散是最主要的传播方式,OXA-23组和OXA-51组D类β-内酰胺酶基因是最主要的碳青酶烯酶基因型,未检测到OXA-24组、OXA-58组I、MP型和VIM型碳青酶烯酶基因,OXA类碳青酶烯酶基因与插入序列ISAba1关系密切。OBJECTIVE To identify the antibiotic resistance, homology and the carbapenemases determinants of imipenem-resistant strains of Acinetobacter baumannii isolated from elderly in the Zhejiang Hospital. METHODS All 142 strains of A. baumannii were isolated from Zhejiang Hospital through Jan 2005 to Jan 2007. K-B method was used to screen imipenem-resistant strains. The MICs of imipenem-resistant strains to 14 antimicrobial agents were determined by agar dilution method. The homology of these isolates was analyzed by pulse-field gel electrophoresis （PFGE）. The coding genes of carbapenamases and the gene environments were investigated by PCR, clone, and sequencing. RESULTS Ninety-seven strains of imipenem-resistant A. baumannii were isolated from 142 strains. All of the strains of carbapenem resistant A. baumannii belonged to 4 epidemic PFGE-clones. Ninety carbapenem resistant strains contained OXA-23-1ike carbapenemase gene and 91 isolates were positive for OXA-51-1ike gene. OXA-23-1ike gene of 86 strains was just on the down-stream of insert sequence ISAbal. OXA-51-like gene of 6 strains had an ISAbal sequence just on the up-stream. CONCLUSIONS All imipenem-resistant strains of A. baurnannii are pan-resistant isolates. Clone dissemination is the most important style of strains spread. No OXA-24-like, OXA-58-1ike, IMP-like, and VIM-like gene are detected. OXA-23-like and OXA-51-like gene are the most popular carbapenemases coding genes of these strains in the Zhejiang Hospital. ISAhal has close relationship with OXA type carbapenemases genes in Zhejiang Hospital.

关 键 词：鲍氏不动杆菌 耐药性 脉冲场凝胶电泳 碳青酶烯酶 插入序列 

分 类 号：R378[医药卫生—病原生物学]