2007-2010四年间鲍曼不动杆菌耐药性变迁及对亚胺培南耐药的机制研究  

4 years migration of Acinetobacter baumannii and mechanisms of resistance to Imipenem from 2007 to 2010

作　　者：陈利达[1] 黄彬[2] 周晓玲[3] 陈树林[1] 

机构地区：[1]中山大学 [2]中山大学附属第一医院检验医学部,广东广州510080 [3]东莞市人民医院检验科,广东东莞523018

出　　处：《中国微生态学杂志》2011年第12期1110-1114,共5页Chinese Journal of Microecology

摘　　要：目的研究2007-2010四年间中山大学附属第一医院临床分离的鲍曼不动杆菌的耐药性迁移情况和耐亚胺培南的鲍曼不动杆菌(IRAB)的耐药机制,为临床抗感染治疗提供依据。方法采用VITEK 2型全自动微生物检测系统对细菌进行鉴定及药敏分析;用PCR方法检测碳青霉烯酶基因blaOXA-51、blaOXA-23、blaOXA-24和blaOXA-58。结果 2007-2010四年间分离鲍曼不动杆菌811株,耐药率逐年上升,其对头孢哌酮/舒巴坦、美罗培南、头孢吡肟、亚胺培南和哌拉西林/他唑巴坦的耐药率上升明显,如对亚胺培南的耐药率自2007-2010年分别为13.1%、26.0%、44.3%和59.5%。811株鲍曼不动杆菌中IRAB有311株,IRAB对抗生素的耐药率明显升高,但四年间的耐药率变化并不明显。对IRAB敏感的抗生素以阿米卡星为首,其次为头孢哌酮/舒巴坦,但头孢哌酮/舒巴坦的敏感率逐年下降。从311株IRAB中随机抽取140株,检出blaOXA-51基因阳性125株(89.3%),blaOXA-23基因阳性29株(20.7%),blaOXA-24基因阳性3株(2.14%),blaOXA-58基因阳性22株(15.7%)。结论鲍曼不动杆菌的耐药性逐年升高,以阿米卡星与头孢哌酮/舒巴坦联合应用为有效的治疗方法,产碳青霉烯酶是IRAB的主要耐药机制。Objective To study the migration of Acinetobacter baumannii resistance in our hospital from 2007 to 2010 and to explore the mechanism of drug resistance to imipenem. Method The Strain identification and antibiotic susceptibility of bacteria was analyzed by VITEK 2 automatic analyzer. Resistant genes such as blaOXA-51, blaOXA-23,blaOXA-24 and blaOXA-58 were determined by PCR. Result The resistance of 811 clinical Acinetobacter baumannff isolates to antibiotics, such as cefoperazone/sulbactam, imipenem, meropenem, cefepime, piperacillin-tazobactam, were getting higher year by year. The imipenem-resistance rate of the Acinetobacter baumannii strains from 2007 to 2010 was 13.1%, 26.0%, 44.3% and 59.5% , respectively. Of the 811 clinical Acinetobacter baumannii isolates, 311 （38.3%） were resistant to imipenem. Imipenem-resistant Acinetobacter baumannii isolates showed the highest sensitivity to amikacin, followed by cefoperazone/sulbactam. The susceptibility rate to cefoperazone/sulbactam decreased significantly. The positive rates of detected genes were as follows： blaOXA-51 （ 89.3% ）, blaOXA-23 （20.7%）, blaOXA-24 （2.14%）, blaOXA-58 （ 15.7% ）. Conclusion The resistance rate of Acinetobacter baumannii to antibiotics was increasing year by year. Combination therapy of cefoperazone/sulbactam plus amikacin is usually an effective treatment for infection by Acinetobacter baumannii. Producing carbapenemases is the major resistance mechanisms of IRAB.

关 键 词：鲍曼不动杆菌 亚胺培南 耐药性 

分 类 号：R378[医药卫生—病原生物学]