鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制研究  

Drug resistance mechanisms of carbapenem-resistant Acinetobacter baumannii

作　　者：丁丽丽 戎建荣[2] 王桂琴[1] DING Li-li;RONG Jian-rong;WANG Gui-qin(Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学微免教研室,山西太原030001 [2]山西医学科学院/山西大医院检验科,山西太原030032

出　　处：《中华医院感染学杂志》2019年第1期10-14,19,共6页Chinese Journal of Nosocomiology

基　　金：山西省留学归国人员科研基金资助项目(2010-14-94)

摘　　要：目的探讨临床分离的鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制,为医院感染控制、临床合理用药提供依据。方法收集山西医学科学院(山西大医院)临床分离的鲍氏不动杆菌株共84株,其中亚胺培南耐药鲍氏不动杆菌(IRAB)63株,亚胺培南敏感鲍氏不动杆菌(ISAB)21株。用K-B纸片法检测以上细菌对常用抗菌药物的敏感性。PCR法分析10种β-内酰胺酶基因和carO、oprD膜孔道蛋白基因,adeB外排泵基因,并对扩增阳性的基因进行测序,同时应用DNASTAR软件对耐药和敏感菌株的carO、oprD序列进行对比分析。结果 63株亚胺培南耐药鲍氏不动杆菌对替加环素较敏感,对头孢哌酮/舒巴坦(28.6%)和米诺环素(30.2%)耐药率较低外,对其他抗菌药物耐药率均较高,而21株亚胺培南敏感鲍氏不动杆菌对多数抗菌药物较敏感;IRAB与ISAB检出TEM、OXA-23、adeB基因阳性率比较,差异有统计学意义(P<0.05),而ADC阳性率差异无统计学意义;84株细菌中carO、oprD和OXA-51均为阳性。亚胺培南耐药株carO编码基因序列与亚胺培南敏感株相比存在有意义突变。结论本研究中耐碳青霉烯类鲍氏不动杆菌耐药机制主要与β-内酰胺酶、adeB外排泵、carO孔道蛋白突变有关。OBJECTIVE To explore the drug resistance mechanisms of clinical isolates of carbapenem-resistant Acinetobacter baumannii so as to provide guidance for control of nosocomial infection and reasonable clinical use of antibiotics.METHODS Totally 84 strains of A.baumannii were collected from Shanxi Academy of Medical Sciences/Shanxi Dayi Hospital,including 63 strains of imipenem-resistant A.baumannii(IRAB)and 21 strains of imipenem-sensitive A.baumannii(ISAB).The drug susceptibility testing was performed for the commonly used antibiotics by using K-B disk method.Ten types of ofβ-lactamases genes,membrane pore protein genes carO,oprD,and efflux pump gene adeB were analyzed by PCR,the genes that were amplified positive were sequenced,and the sequences of carOand oprD were observed and compared between the drug-resistant strains and the drugsensitive strains by using DNASTAR software.RESULTS The 63 strains of IRAB were sensitive to tigecycline,the drug resistance rates to cefoperazone-sulbactam and minocycline were respectively 28.6% and 30.2%,and the strains were highly resistant to other antibiotics;the 21 strains of ISAB were susceptible to most of the antibiotics.There were significant differences in the positive rates of TEM,OXA-23 and adeB genes between the IRAB strains and the ISAB strains(P<0.05),however,there was no significant difference in the positive rate of ADC.The carO,oprDand OXA-51 were tested positive in the 84 strains.As compared with the ISAB strains,the IRAB strains had significant mutations in membrane porin carO.CONCLUSION The drug resistance mechanisms of the carbapenem-resistant A.baumannii strains are mainly associated with theβ-lactamases genes,efflux pump gene adeBand mutation in membrane porin carO.

关 键 词：鲍氏不动杆菌 碳青霉烯类 Β-内酰胺酶基因 膜孔蛋白 耐药机制 

分 类 号：R378[医药卫生—病原生物学]