碳青霉烯不敏感鲍曼不动杆菌耐药性与碳青霉烯酶耐药基因检测  

Antibiotic Resistance and Carbapenemase Gene Detection in Carbapenem-non-susceptible

作　　者：李文青[1,2] 吴伟元[1,2] 卢月梅[1,2] 吴劲松[1,2] 程锦娥[1,2] 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院检验科深圳市病原微生物及细菌耐药监控重点实验室,广东深圳518020

出　　处：《实用预防医学》2013年第5期549-552,共4页Practical Preventive Medicine

基　　金：深圳市科技计划项目(201103336)

摘　　要：目的调查碳青霉烯不敏感鲍曼不动杆菌（CNSAB）的耐药性及其产碳青霉烯酶的基因型,探讨其耐药机制。方法采用琼脂稀释法检测美罗培南等15种抗菌药对2009年深圳市人民医院住院患者分离CNSAB（美罗培南或亚胺培南MIC≥8 mg/L）的最低抑菌浓度（MIC）,采用多重PCR法分别检测OXA-51-like、OXA-23-like、OXA-24-like、OXA-58-like和OXA-143-like型酶基因及IMP、VIM、GIM、SPM和SIM型金属酶基因;PCR分别扩增OXA-51-like型酶基因上游插入序列ISAba1和KPC酶基因。对扩增的碳青霉烯酶基因产物测序确定其基因型。结果 109株CNSAB对亚胺培南、美罗培南、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、头孢吡肟、阿米卡星、环丙沙星、左氧氟沙星、复方新诺明高度耐药（耐药率86.2%~100%）,且多重耐药。多粘菌素B对CNSAB抗菌活性最强,敏感率100%,MIC50和MIC90均为1 mg/L;其次为米诺环素,敏感率94.5%,MIC50和MIC90均为4mg/L。92.7%（101/109）CNSAB检出OXA-23型基因,4.6%（5/109）CNSAB检出OXA-58型基因,2.8%（3/109）CNSAB检出OXA-66基因上游携带ISAbal;未发现OXA-24-like基因、OXA-143-like基因。所有菌株均未检出IMP、VIM、GIM、SPM、SIM型金属酶基因和KPC酶基因。结论携带OXA-23型碳青霉烯酶基因是本院CNSAB对碳青霉烯耐药的主要因素;本院CNSAB对多粘菌素B和米诺环素高度敏感。Objective To investigate the antibiotic resistance and carbapenemases genotypes in carbapenem-non-susceptible acinetobacter baumannii（CNSAB） isolates from Shenzhen People＇s Hospital,and to explore the mechanisms of drug resistance.Methods A total of 109 CNSAB strains（MIC of meropenem or imipenem ≥8 mg/L） were collected from Shenzhen People＇s Hospital in 2009.The resistance of CNSAB to 15 antibiotics indicated by MIC was tested by agar dilution method.OXA-type genes（OXA-51-like,OXA-23-like,OXA-24-like,OXA-58-like and OXA-143-like genes）and metallo-β-lactamase genes（IMP,VIM,GIM,SPM and SIM genes） were detected by multiplex-PCR.The insertion sequences ISAba1 and KPC enzyme genes in the upstream of the OXA-51-like genes were amplified by PCR.The amplified carbapenemase gene products were sequenced to determine the genotypes.Results The resistance rates of 109 CNSAB strains to imipenem,meropenem,cefoperazone/sulbactam,ampicillin/sulbactam,piperacillin/tazobactam,ceftazidime,ceftriaxone,cefepime,amikacin,ciprofloxacin,levofloxacin and sulfamethoxazole were very high,from 86.2% to 100%.All strains were multi-drug resistant.The CNSAB were most sensitive to polymyxin B,with a sensitive rate of 100%,and MIC50 and MIC90 were both 1 mg/L.The sensitive rate of the CNSAB to minocycline was the second,94.5%,and MIC50 and MIC90 were both 4 mg/L.Carbapenemase gene blaOXA-23 was detected in 92.7%（101/109） of the CNSAB strains,and blaOXA-58 was detected in 4.6%（5/109）.The insertion sequence ISAba1 in the upstream of OXA-66 gene was found in 2.8%（3/109）.OXA-24-like gene and OXA-143-like gene were not detected.All strains were negative for metallo-β-lactamase genes（IMP,VIM,GIM,SPM and SIM） and KPC enzyme genes.Conclusions Carrying OXA-23 type carbapenemase gene is the most important reason for the drug resistance of CNSAB isolates in Shenzhen People＇s Hospital.The CNSAB stains are hypersensitive to polymyxin B and minocycline.

关 键 词：鲍曼不动杆菌 耐药性 碳青霉烯酶 OXA-23 聚合酶链反应 

分 类 号：R378[医药卫生—病原生物学]