临床常见的革兰阴性杆菌耐药情况及其aac(6’)-Ib-cr基因检测结果分析  

Study of Common Clinical Gram-negative Bacilli Resistance and Its aac(6')-Ib-cr Gene Test Results

作　　者：吴玉红[1] 白丽霞[1] 杨虹[1] 

机构地区：[1]北京大学深圳医院检验科,广东深圳518036

出　　处：《中国实验诊断学》2012年第6期1050-1052,共3页Chinese Journal of Laboratory Diagnosis

基　　金：深圳市科技计划资助项目(201102017)

摘　　要：目的了解我院临床常见的革兰阴性杆菌的耐药状况及其质粒介导的能使喹诺酮类和氨基糖甙类药物同时耐药的基因aac(6’)-Ib-cr的流行分布状况和比较分析。方法用微量肉汤稀释法测定2010年从临床分离的299株临床常见的革兰阴性杆菌(53株鲍曼不动杆菌、66株铜绿假单胞菌、83株大肠埃希菌和97株肺炎克雷伯菌)的MIC值。采用PCR检测所有菌株的aac(6’)-Ib基因;并以内切酶BtsCI酶切消化aac(6’)-Ib的PCR阳性产物以确定aac(6’)-Ib-cr。结果氨苄西林耐药率最高,达75.3%,其次是头孢唑林,耐药率为58.5%;环丙沙星和左氧氟沙星的耐药率分别为25.1%和16.7%;哌拉西林/他唑巴坦、阿米卡星和亚胺培南的敏感率均在90%以上。共检出aac(6’)-Ib基因29株,其中有21株变异为aac(6’)-Ib-cr,变异率为72.4%(21/29);aac(6’)-Ib-cr的总阳性率为7.0%(21/299),其中大肠埃希菌有9株及肺炎克雷伯菌有22株,其阳性率为11.67%(21/180),而在鲍曼不动杆菌和铜绿假单胞菌中未检出aac(6’)-Ib-cr(0.0%,0/119);经χ2检验,两者间的差异具有统计学意义(χ2=14.932,P<0.01)。结论目前哌拉西林/他唑巴坦、阿米卡星和亚胺培南为抗感染治疗的首选药;环丙沙星的耐药率较高,要慎选,而左氧氟沙星耐药率相对低一些,可优先于环丙沙星选用。aac(6’)-Ib-cr基因在肠杆菌科细菌与非发酵细菌中的分布差异具有统计学意义。Objective To investigat the clinical common Gram-negative bacilli resistance in our hospital and the dis- tribution of the plasmid-mediated quinolone and aminoglycosides resistance gene aac（6＇）-Ib-cr among them. Methods Determination of the MIC from 299 of clinical common gram-negative bacilli strains （53 and 66 strains of Acinetobacter baumannii and Pseudomonas aeruginosa, 83 and 97 strains of Eseherichia coli and Klebsiella pneumoniae） by micro- broth dilution in 2011. Aac（6＇ ）-Ib gene by PCR detection of all strains, aac（6＇）-Ib- cr gene was further identified by the digestion with BtsCI. Results The ampicillin resistance is the highest rate of 75.3% ,Followed by cefazolin resistance rate of 58.5 %;Ciprofloxacin and levofloxacin resistance rates were 25.1% and 16.7 %;Piperacillin/tazobactam, imipenem and amikacin sensitive rates of above 90%. Detected a＇ac（6＇）-Ib gene in 29 strains,including 21 variations is aac（6＇）-Ib-cr,the variation rate is 72, 4%（21/29）. The positive rate aac（6＇）-Ib-cr was 7.0% （21/299） in total,and of Escherichia coli 9 and Klebsiella pneumoniae 22, the positive rate was 11.67. % （21/180）, but Acinetobacter baumannii and Pseudomonas aeruginosa were not detected the aac（6＇）-Ib-cr （0.0 %, 0/119）;There is significant difference between the two groups （X^2 =14. 932,P〈0.01）. Conclusion At present,piperacillin/tazobactam,amikacin and imipenem as the preferred drug for anti-infective therapy;Ciprofloxacin resistance rate to be cautious in the selection, the levofloxacin resistance rate relatively lower and Selection priority for ciprofloxacin. The distribution difference of aac（6＇） Ib-cr gene between the Enterobacteriaceae and non-fermenting bacteria was statistically significant.

关 键 词：革兰阴性杆菌 耐药 质粒介导耐药 喹诺酮类 aac(6’)-Ib-cr 

分 类 号：R446.5[医药卫生—诊断学]