鲍氏不动杆菌产碳青酶烯酶基因型检测及其耐药性研究  

Genotype and Drug Resistance of Carbapenemases Produced by Acinetobacter baumannii

作　　者：周东升[1] 沈志君[2] 林荣[2] 潘晓龙[1] 唐吉斌[1] 

机构地区：[1]铜陵市人民医院检验科,安徽铜陵244000 [2]铜陵市人民医院感染管理科,安徽铜陵244000

出　　处：《中华医院感染学杂志》2010年第24期3851-3855,共5页Chinese Journal of Nosocomiology

基　　金：安徽省铜陵市卫生局科研课题资助项目(卫科研[2009]6)

摘　　要：目的了解医院鲍氏不动杆菌（ABA）产碳青酶烯酶基因型分布及其与碳青酶烯类等临床常用抗菌药物耐药的相关性。方法收集医院2008年1-12月临床分离的100株ABA,PCR检测所有菌株I MP、VI M-1、VI M-2、SI M-1、OXA-23、OXA-24、OXA-51、OXA-58等碳青酶烯酶基因型;用纸片扩散（K-B）法检测其对16种常用抗菌药物的耐药性;用E-test法检测产不同碳青酶烯酶基因型ABA对亚胺培南、美罗培南的MIC值。结果 100株ABA有78株产OXA-66型碳青酶烯酶、31株产OXA-23型碳青酶烯酶、其中30株同时产OXA-66型和OXA-23型碳青酶烯酶;21株非产碳青酶烯酶菌株对常用抗菌药物的耐药率除头孢哌酮为38.1%外,其余均〈10.0%;单产OXA-66型碳青酶烯酶菌株除对亚胺培南、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、哌拉西林/他唑巴坦的耐药率分别为0、10.4%、33.3%和47.9%外,对其他抗菌药物耐药率均〉50.0%;而同时产OXA-23、OXA-66型碳青酶烯酶菌株除对头孢哌酮/舒巴坦耐药率为53.3%外,对其余抗菌药物耐药率均〉95.0%;非产碳青酶烯酶菌株对IPM、MEM的MIC值均在0.19~0.5μg/ml,而单产OXA-66型碳青酶烯酶菌株则在2~4μg/ml,所有产OXA-23型碳青酶烯酶菌株则均〉32μg/ml。结论 OXA-66型碳青酶烯酶在医院ABA中广泛存在,产碳青酶烯酶菌株的耐药率显著高于非产碳青酶烯酶菌株;OXA-66型碳青酶烯酶对碳青酶烯类药物呈低水平耐药;OXA-23型碳青酶烯酶水解碳青酶烯类药物的能力可能强于OXA-66型;同时产OXA-23型和OXA-66型碳青酶烯酶可能是导致ABA对碳青酶烯类药物高度耐药的主要原因。OBJECTIVE To investigate the genotype distributions of carbapenemases produced by Acinetobacter baumannii and the relateness of drug resistance of antibiotics suehas carbapenem.METHODS A hundred strains of isolated A.baumannii between Jan 2008 and Dec 2008 in our hospital were collected,the genotypes of all strains including IMP,VIM-1,VIM-2,SIM-1,OXA-23,OXA-24,OXA-51,and OXA-58 were detected by PCR,the drug resistance to 16 kinds of commonly used antibiotics was detected by disk diffusion（K-B）;the MICs of imipenem（IPM）,and meropenem（MEM） against different carbapenemases-producing A.baumannii were detected by E-test.RESULTS Of 100 strains,78 strains produced carbapenemase OXA-66,31 strains produced carbapenemase OXA-23,of which 30 strains produced both carbapenemase OXA-66 and OXA-23.The drug resistance rates of 21 non-carbapenemase-producing strains to commonly used antibiotics except cefoperazone were 38.1%,all of the rest were below 10%.The resistance rates of OXA-66 type carbapenemase-producing strains only to IPM,cefoperazone/sulbactam,ampicillin/sulbactam,piperacillin/tazobactam were 0%,10.4%,33.3% and 47.9%,but to other antibiotics were all above 50.0%;while producing OXA-23 and OXA-66 carbapenemases strains apart from cefoperazone/sulbactam resistance rates were 53.3%,the resistance rates to other antibiotics were more than 95.0%.The MICs of the non-carbapenemases-producing strains to IPM and MEM were between 0.19 μg/ml and 0.5 μg/ml.While the MICs of OXA-66 carbapenemase-producing strains were the 2-4 μg/ml,those of all of the OXA-23 producing strains were more than 32 μg/ml.CONCLUSIONS The carbapenemase gene OXA-66 in A.baumannii widely occurrs in hospital;the drug resistance rates of the carbapenemases-producing strains are significantly higher than that of non-carbapenemases-producing strains.The drug resistance of OXA-66 strains to carbapenem is at low level;the hydrolysis ability of carbapenemase OXA-23 to drugs is likely to be stronger than that of OXA-66;carbapenemases OXA-23 and OX

关 键 词：鲍氏不动杆菌 碳青酶烯酶 基因型 耐药率 亚胺培南 

分 类 号：R378[医药卫生—病原生物学]