重症监护病房鲍氏不动杆菌5年耐药监测及同源性分析  

Antibiotic Susceptibility and Homological Profile in Acinetobacter baumannii Isolated During Five Years

作　　者：董晓勤[1] 周田美[1] 徐丽慧[1] 沈强[1] 范建中[1] 汪涛[1] 

机构地区：[1]杭州市第一人民医院检验科,浙江杭州310006

出　　处：《中华医院感染学杂志》2010年第10期1465-1468,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划项目(2008A129)

摘　　要：目的了解重症监护病房鲍氏不动杆菌的临床分布和耐药变迁,旨在为制定预防和控制其医院感染的措施提供依据。方法采用全自动微生物分析系统VITEK-AMS60对566株鲍氏不动杆菌进行鉴定,采用纸片扩散法(K-B法)对临床分离株作药敏试验,参照CLSI为判断标准,耐药数据分析采用WHONET5.4软件,同时以脉冲场凝胶电泳进行其同源性分析,PCR检测相关耐药性基因。结果 2004年1月～2008年12月共分离出鲍氏不动杆菌566株,主要来源于呼吸道标本,分离率为86.9%,分离株和耐药率有逐年增加的趋势;连续5年监测了18种抗菌药物,12种抗菌药物耐药率均>90.0%,亚胺培南95.6%、美罗培南91.4%、头孢他啶76.7%、阿米卡星75.1%、庆大霉素70.3%、头孢哌酮/舒巴坦57.3%、多黏菌素E20.0%;脉冲场凝胶电泳研究发现34株耐亚胺培南鲍氏不动杆菌为同一耐药克隆株,在重症监护病房呈暴发流行;PCR明确产OXA-23型碳青酶烯酶,未检出OXA-24、IMP、VIM基因型。结论多药耐药和泛耐鲍氏不动杆菌逐年增多,头孢哌酮/舒巴坦和多黏菌素E是治疗多药耐药鲍氏不动杆菌的首选药物,连续动态监测重症监护病房鲍氏不动杆菌的耐药变迁,对临床治疗其引起的感染具有十分重要的意义。OBJECTIVE To survey the prevalence of the Acinetobacter baumannii isolated from ICU and related trend of antibiotic susceptibility during from Jan 2004 to Jun 2008,and to provide a cue for preventing and controlling hospital acquired infections.METHODS According to Clinical and Laboratory Standards Institute（CLSI）Guidelines of the USA,the susceptibility for antibiotic was determined by K-B test and the data were analyzed by WHONET 5.4,following the identification of 566 strains of A.baumannii by VITEK-AMS60.Homological profile of these isolates was performed by pulsed field gel electrophoresis（PFGE）,along with PCR detecting related anti-drug genes.RESULTS A total of 566 strains of A.baumannii were isolated during the five-year period with the majority of 86.9% from sputum specimen.The incidences of A.baumannii isolates and antibiotic resistance increased annually.Among all of the 18 antimicrobial agents monitored in the five years,12 presented resistance rate above 90.0%,with imipenem being resistance against A.baumannii at the rate of 95.6%,meropenem 91.4%,ceftazidime 76.7%,amikacin 75.1%,gentamicin 70.3%,cefperazone/sulbactam 57.3%,and polymyxin E 20.0%,respectively.PFGE pattern of 34 isolates revealed the identical clone relationships of the resistant A.baumannii,confirming the outbreaks of resistant strains in ICU.OXA-23 type carbapenemase was detected in all isolates,but none of the OXA-24,IMP and VIM for all isolates.CONCLUSIONS The multidrug-resistant A.baumannii is increasing annually,as well as pandrug-resistant one.Cefoperazone/sulbactam and polymyxin E are be priority drugs to treat infections caused by multidrug-resistant A.baumannii.It is vital to undertake a continuous monitoring of the trend of antibiotic susceptibility of A.baumannii from ICU for effective therapyeutic options.

关 键 词：鲍氏不动杆菌 耐药性 脉冲场凝胶电泳 动态监测 预防 

分 类 号：R378[医药卫生—病原生物学]