下呼吸道感染鲍曼不动杆菌的耐碳青霉烯酶基因检测  

Detection of carbapenem resistance gene in Acinetobacter baumannii in lower respiratory tract infections

作　　者：沈欣[1] 朱家馨[1] 李涵质[1] 张开宝[1] 杨海玲[1] 彭宣宪[2] 张天托[1] 

机构地区：[1]中山大学附属第三医院呼吸内科,广州市510630 [2]中山大学生命科学学院,广州市510275

出　　处：《实用医学杂志》2013年第8期1345-1347,共3页The Journal of Practical Medicine

基　　金：中山大学交叉学科资助计划(编号:A01586)

摘　　要：目的:了解我院2011年下呼吸道鲍曼不动杆菌感染的耐药现状及碳青霉烯酶耐药基因的分布状况。方法:收集我院肺部感染患者下呼吸道分泌物中分离的鲍曼不动杆菌,经API系统鉴定;K-B纸片法筛选泛耐药菌株;M-H琼脂稀释法测定最低抑菌浓度(MIC);RAPD分型分析菌株同源关系;改良Hodge实验鉴定碳青霉烯酶表型并对碳青霉烯酶基因(OXA-23,NDM-1,IMP,VIM)进行PCR扩增。结果:下呼吸道分泌物标本中共分离出鲍曼不动杆菌95株,对13种抗菌药物的平均耐药率为31.4%～91.7%。其中30株为泛耐药菌株,存在5种克隆流行株。有27株携带有OXA-23基因,未扩增出B类金属酶基因。结论:我院下呼吸道感染鲍曼不动杆菌的耐药情况严峻,并存在院内感染及水平克隆传播的可能;产OXA-23型碳青霉烯酶是我院鲍曼不动杆菌泛耐药的主要机制。Objective To investigate the current status of drug resistance and the genes encoding carbapenem resistance of Aeinetobacter baumanni in lower respiratory tract infections in our hospital in 2011. Methods Acinetobacter banmannii strains, which were screened out from lower respiratory tract secretions in patients with pulmonary infection, were identified by API system. Then the pan-drug resistant was screened by KB method; the MIC was detected by MH agar dilution method; the bacterial genotype was analyzed by random amplified polymorphic DNA （RAPD）. Improved Hodges test were used for carbapenemase phenotype identification and PCR for carbapenemase genes （OXA-23, NDM-1, IMP, VIM）. Results A total of 95 strains of Aeinetobacter baumanni were collected from lower respiratory tract secretions and the drug resistant rate were 31.4% -91.7%. 30 strains of pan-resistant Acinetobacter baumannii had high resistant level. There were no blaNDM-1 carbapenem-resistance gene; blaOXA-23 were detected in 27 Acinetobacter baumannii. Conclusions Acinetobacter banmannii from our hospital were mostly multi-drug resistant or even pan-drug resistant. It assumed that there existed the possibility of the spread of nosocomial infection on cloning level. The production of non- metallic enzyme OXA-23 was the main mechanism of pan-drug resistant Acinetobacter baumannii in our hospital.

关 键 词：泛耐药 鲍曼不动杆菌 碳青霉烯酶 

分 类 号：R440[医药卫生—诊断学]