耐碳青霉烯鲍曼不动杆菌流行特征及耐药基因分析  

Epidemiological characterization and carbapenemases genotypes of carbapenem- resistant Acinetobacter baumannii

作　　者：杨均均[1] 黄文祥[1] 史芳静[1] 刘成伟[1] 李崇智[1] 

机构地区：[1]重庆医科大学附属第一医院感染科,重庆市传染病寄生虫病重点实验室,重庆400016

出　　处：《中国抗生素杂志》2012年第5期343-347,391,共6页Chinese Journal of Antibiotics

基　　金：重庆市自然科学基金项目(CSTC2008BB5393);重庆市教育委员会科技项目(KJ100311)

摘　　要：目的调查分析我院2009年医院内获得性鲍曼不动杆菌对各种抗菌药物的耐药性,研究耐碳青霉烯鲍曼不动杆菌感染的克隆流行情况以及碳青霉烯酶基因型。方法用琼脂稀释法进行药敏试验,按CLSI(2009)标准判断细菌耐药性,并用PFGE法对2009年的102株对碳青霉烯耐药菌进行同源性分析,多重PCR扩增碳青霉烯酶基因bla_(OXA-51like),bla_(OXA-24like),bla_(OXA-58like)。结果药敏试验结果显示鲍曼不动杆菌对米诺环素、替加环素、多粘菌素B耐药率较低,对碳青霉烯耐药高。PFGE结果显示我院存在A/B/C克隆株流行,主要分布于呼吸科以及ICU等病房,时间上呈散发流行。102株耐碳青霉烯鲍曼不动杆菌产OXA-23型碳青霉烯酶率为71.6%,产OXA-51型碳青霉烯酶率为84.3%,另外仅2株检出OXA-24型碳青霉烯酶,3株检出()XA-58型碳青霉烯酶。结论我院在呼吸科以及ICU等病房存在A/B/C克隆株流行,碳青霉烯酶基因型以OXA-23、OXA-51型为主,由于对多种抗菌药物尤其是碳青霉烯类抗生素耐药性的增强和克隆株的流行,应积极采取有效措施预防和控制鲍曼不动杆菌感染。Objective To investigate the antibiotic resistance of nosocomial infection by Acinetobacter baumannii in our hospital in 2009, and analysis the outbreak of carbapenem-resistant Acinetobacter baumannii and the genotype of OXA-carbapenemases. Methods Antimicrobial susceptibility testing was performed using broth micro dilution on 272 strains ofA. baumannii isolated from our hospital in 2009 according to the NCCLS guidelines for MIC testing.The homology of 102 strains of carbapenem-resistant A. baumannii （CRAB） in 2009 was studied by PFGE, the genotype of OXA-carbapenemases （blaOXA-51like, blaOXA-23like, blaOXA-24like and blaOXA-58like） was detected by a novel multiplex polymerase chain reaction （PCR）. Results The drug resistance rate of A. baumannii to common antimicrobial agents increased year by year, the resistance rate tominocycline, doxycycline, polymyxin B was lowest, resistance to carbapenems raised faster. PFGE results showed that there was outbreak of A/B/C cloning strains in ICU and pneumology department etc,and scattered between monthes in 2009. In 102 strains of carbapenem-resistant A. baumannii, 71.6% of strains produced carbape nemases which were confirmed as OXA-23 by multiplex PCR, and 84.3% of strains produced OXA-51 carbape nemases,only 2 strains produced OXA-24 carbape nemases, 3 strains produced OXA-58 carbape nemases. Conclusion There was outbreak of A/B/C cloning strains in ICU and pneumology department etc in our hospital, OXA-23 and OXA-51 carbape nemases were the most popular genotypes. Because of high resistance rate of drugs especially carbapenems and prevalence of cloning strains, it is necessary to strengthen the clinic monitoring to prevent and contral the clinical infection of A. baumannii.

关 键 词：鲍曼不动杆菌 耐药性 克隆流行 碳青霉烯酶 医院感染 

分 类 号：R378[医药卫生—病原生物学]