多药耐药鲍氏不动杆菌菌株亲缘性分析  

Phylogenetic Analysis of Multi-drug Resistant Acinetobacter baumannii Strains

作　　者：朱健铭 姜如金[1] 吴康乐[1] 王建敏[1] 

机构地区：[1]杭州市余杭区中医院检验科,浙江杭州311106

出　　处：《中华医院感染学杂志》2010年第3期312-315,共4页Chinese Journal of Nosocomiology

基　　金：杭州市余杭区重大科技项目(2008001);杭州市卫生科技计划项目(2008B0113);杭州市科技发展计划项目(20090833B35)

摘　　要：目的了解多药耐药鲍氏不动杆菌（MDR—ABA）临床分离株的亲缘性。方法在2007年11月～2008年2月从浙江大学医学院附属第-医院住院患者中分离62株MDR—ABA，采用聚合酶链反应（PCR）及序列分析的方法检测β-内酰胺酶基因、氨基糖苷类耐药基因（含氨基糖苷类修饰酶基因、16SrRNA甲基化酶基因）和喹诺酮类、利福平、四环素、氯霉素、磺胺类耐药基因，多种药物外排泵基因以及质粒、转座子、整合子遗传标记等68种基因，并以该68种基因为分子标记，对检测结果作样本聚类分析。结果62株中TEM、ADC、OXA-23、gyrA突变、aac（3）-I、aac（6’）-Ib、ant（3”）-I、aph（3’）-I、aph（3’）-Ⅱb、tetB、mdfA、tehA、qacE△1-sul1、intI1、tnpU和tnp513基因阳性率分别为82．2％、58．1％、80．6％、83．9％、12．9％、35．5％、35．5％、30．6％、3．2％、74．2％、100．0％、12．9％、58．1％、54．8％、54．8％和56．4％，聚类分析示存在克隆传播现象，有两个流行株，并已发生衍化。结论调查MDR—ABA多药耐药表型与基因检测状况相符，MDR—ABA可导致克隆传播医院感染，多基因聚类分析法是判断医院感染流行株的可靠方法，对临床治疗和医院感染的防控具有指导意义。OBJECTIVE To investigate the phylogenetics of multi-drug resistant Acinetobacter baumannii(MDR-ABA) strains isolated from the clinic.METHODS From November 2007 to February 2008,62 strains of MDR-ABA were isolated from the First Affiliated Hospital of Zhejiang University School of Medicine,China.Then,68 kinds of genes(beta-lactamase genes,aminoglycoside modifying enzyme genes,16S rRNA methylase genes,and resistance genes to quinolones,rifampicin,tetracycline,chloramphenicol,sulfonamides,as well as drug efflux genes,and genetic markers of plasmid,transposon and integron) were analyzed by PCR and verified by DNA sequencing,and furthermore used as molecular markers to perform cluster analysis.RESULTS The positive rates of TEM,ADC,OXA-23 cluster,gyrA mutation,aac(3)-Ⅰ,aac(6′)-Ⅰb,ant(3″)-Ⅰ,aph(3′)-Ⅰ,aph(3′)-Ⅱb,tetB,mdfA,tehA,qacE△1-sul1,intⅠ1,tnpU and tnp513 were 82.2%,58.1%,80.6%,83.9%,12.9%,35.5%,35.5%,30.6%,3.2%,74.2%,100.0%,12.9%,58.1%,54.8%,54.8% and 56.4%,respectively.According to cluster analysis,62 strains of MDR-ABA could be classified into 2 subgroups,which had the same ancestor.So,it indicated that 2 epidemic strains were in existence and derivation occurred in this hospital.CONCLUSIONS Coincidence of MDR-ABA between resistant phenotypes and genotypes in this investigation is reasonable,and MDR-ABA can induce clone-transmitted hospital infection.In addition,cluster analysis is a reliable method to judge epidemic strain of hospital infection,treat in clinic and prevent and control hospital infection.

关 键 词：鲍氏不动杆菌 多药耐药 基因 亲缘性 聚类分析 

分 类 号：R378[医药卫生—病原生物学]