碳青霉烯类耐药鲍曼不动杆菌耐药基因的研究  

Acinetobacter Baumannii Drug Resistance and Resistance Genes Related to Carbapenems

作　　者：李光荣[1] 宋敏[1] 杨建波[1] 刘靳波[1] 

机构地区：[1]泸州医学院附属医院检验科,四川省泸州市646000

出　　处：《中国全科医学》2014年第26期3083-3087,共5页Chinese General Practice

基　　金：四川省卫生厅科研课题(110359);泸州市科技计划项目[2011-S-38(2/4)];泸州医学院青年基金课题(泸医院【2010】108号)

摘　　要：目的探讨鲍曼不动杆菌耐药性及碳青霉烯酶相关耐药基因OXA-23、OXA-24、OXA-58、IMP、VIM的分布情况,为临床抗菌药物的合理选择提供依据。方法 2012年1月—2013年5月收集泸州医学院附属医院临床标本（包括痰、分泌物、脑脊液、尿、血液、咽拭子等标本）中88株多重耐药鲍曼不动杆菌（MDR-Ab）,使用MicroScan WalkAway 96全自动微生物鉴定/药敏测试系统筛选出88株鲍曼不动杆菌;采用PCR检测鲍曼不动杆菌携带的碳青霉烯酶相关耐药基因OXA-23、OXA-24、OXA-58、IMP、VIM,并对耐药基因扩增的阳性产物进行DNA序列分析。结果 88株MDR-Ab对15种抗菌药物的耐药率为：对亚胺培南耐药率为54.5%,对头孢他啶、头孢噻肟、哌拉西林耐药率均为86.4%,对其他抗菌药物的耐药率为71.6%~86.4%。对5种耐药基因的检测结果为：47株（53.4%）携带OXA-23基因,9株（10.2%）携带OXA-58基因,16株（18.2%）携带VIM基因,2株（2.3%）携带OXA-23、OXA-58和VIM基因,5株（5.7%）携带OXA-23和OXA-58基因,14株（15.9%）携带OXA-23和VIM基因,未检测到携带IMP和OXA-24基因的MDR-Ab。48株碳青霉烯类药物耐药鲍曼不动杆菌中,34株（70.8%）携带OXA-23,9株（18.8%）携带OXA-58,15株（31.3%）携带VIM,13株（27.1%）携带OXA-23＋VIM基因,5株（10.4%）携带OXA-23＋OXA-58基因,2株（4.2%）携带OXA-23＋OXA-58＋VIM基因。DNA序列分析结果显示：OXA-23、OXA-58、VIM 3种基因分别与NCBI的序列同源性为99%、99%和97%~99%。结论鲍曼不动杆菌耐药性强,OXA-23型基因可能是鲍曼不动杆菌对碳青霉烯酶类抗菌药物耐药的主要原因,携带多种耐药基因是导致鲍曼不动杆菌对多种常用抗菌药物耐药的重要原因。Objective To study the Acinetobacter baumannii（ Ab） drug resistance and the distribution of carbapenems resistance genes OXA- 23,OXA- 24,OXA- 58,IMP,VIM,to provide a basis for rational choice of antimicrobial drugs. Methods MicroScan WalkAway 96 automated microbial identification sysceptibility testing system was used and 88 strains of clinical samples screened out. Aarbapenems related drug resistance genes（ OXA- 23,OXA- 24,OXA- 58,IMP,VIM） carried by Ab were detected by PCR and a DNA sequence analysis performed on the amplification products of drug resistance genes. Results The drug resistance rates of 88 strains of multi- drug resistant Ab to 15 antibacterials were： 54. 5% to imipenem,86. 4% to ceftazidime,cefotaxime,piperacillin,71. 6%- 86. 4% to other antibacterials. The test results of 5 drug resistance genes were： 47 strains（ 53. 4%） carrying OXA- 23 gens,9（ 10. 2%） carrying OXA- 58 gene,16（ 18. 2%）carrying VIM genes,2（ 2. 3%） carrying OXA- 23,OXA- 58 and VIM genes,5（ 5. 7%） carrying OXA- 23 and OXA- 58 genes,14（ 15. 9%） carrying OXA- 23 and VIM genes. MDR- Ab carrying IMP and OXA- 24 was not detected. In 48 strains of Ab resistant to carbapenems,34（ 70. 8%） carried OXA- 23,9（ 18. 8%） carried OXA- 58,15（ 31. 3%） carried VIM,13（ 27. 1%） carried OXA- 23 ＋ VIM genes,5（ 10. 4%） carried OXA- 23 ＋ OXA- 58 genes,2（ 4. 2%） carried OXA- 23 ＋ OXA- 58 ＋ VIM genes. DNA sequence analysis showed that the sequence homologies between OXA- 23,OXA- 58,VIM genes and NCBI were 99%,99%,97%- 99%,respectively. Conclusion The drug resistance of Ab is serious.OXA- 23 gene may be the main reason for Ab resistance to carbapenems. Carrying multi- drug resistance genes is an important reason for Ab resistant to many commonly- used antimicrobials.

关 键 词：鲍氏不动杆菌 耐药性 耐药基因 

分 类 号：R37[医药卫生—病原生物学]