尿液分离鲍曼不动杆菌耐药性及喹诺酮耐药机制研究  

Antimicrobial resistance and quinolone resistance mechanism of Acinetobacter baumannii isolated from urine

作　　者：吴立新[1] 张利诚[1] 洪志丹 唐小平[3] 

机构地区：[1]武警浙江省总队医院呼吸内科,浙江嘉兴314000 [2]金华浦江县人民医院内二科,浙江金华322200 [3]浙江大学医学院附属第一医院呼吸内科,浙江杭州310006

出　　处：《中国微生态学杂志》2015年第1期72-75,共4页Chinese Journal of Microecology

摘　　要：目的研究武警浙江省总队医院尿液分离鲍曼不动杆菌患者的临床特点、细菌的耐药性及菌株对喹诺酮的耐药机制。方法收集2011年1月至2011年12月临床尿液标本中分离的鲍曼不动杆菌,回顾性分析患者的临床特点,分析其对临床常用抗菌药物的耐药性,并使用PCR方法筛查qnr A、qnr B、qnr S、qep A、aac(6')-Ib-cr,gyr A和par C基因,并对阳性结果进行基因测序分析。结果共收集尿液分离鲍曼不动杆菌53株,均分离自住院患者,其中重症监护病房和外科病房患者占88.7%、留置导尿患者占94.3%,拨除导尿管并给予适当抗菌治疗后临床预后良好。菌株对临床常见抗菌药物耐药率较高,其中头孢哌酮/舒巴坦较低为15.1%、米诺环素为20.8%、阿米卡星为22.6%、美罗培南为26.4%、亚胺培南为28.3%、氨苄西林/舒巴坦为32.1%,其余药物耐药率超过40%。25株环丙沙星耐药菌株中有17株gyr A基因突变,12株par C基因突变,1株qnr B基因阳性,未发现qep A阳性菌株,7株aac(6')-Ib阳性,经序列分析确定未发生aac(6')-Ib-cr突变。结论尿液分离鲍曼不动杆菌主要来自于院内接受留置导尿的患者,其对抗菌药物耐药率较高,合适的治疗临床预后良好。对喹诺酮耐药机制主要为gyr A和par C基因突变,并出现了qnr B基因。Objective To analyze the clinical features of patients with Acinetobacter baumannii urinary tract infection,the resistance and quinolone resistance mechanism of these isolates. Methods Clinical strains of A. baumannii isolated from urine were collected through January to December,2011 in a hospital of Jiaxing. The clinical features of these patients were retrospectively analyzed. Resistant characteristics of these isolates were also studied.PCR was used to detect the quinolone resistant genes,including qnr A,qnr B,qnr S,qep A,aac（ 6＇）-Ib-cr,gyr A and par C. Sequence analysis was performed to confirm the resistant genes. Results A total of 53 A. baumannii were isolated,among which 88. 7% were from patients in ICU or surgery department,and 99. 3% were from patients indwelled urethral catheter. The removal of urethral catheter and appropriate antibiotics resulted in good outcomes. These strains were highly resistant to most of Penicillins,Cephamycins,Extended-spectrum Cephalosporins,Carbapenems,Monobactams,Quinolones and Aminoglycosides. The resistance rates to Cefoperazone / sulbactam,Minocycline,Amikacin,Meropenem,Imipenem,Ampicillin / sulbactam and Ciprofloxacin were 15. 1%,20. 8%,22. 6%,26. 4%,28. 3%,32. 1% and 47. 1%,respectively. Among the 25 Ciprofloxacin-resistant isolates,mutations of gyr A and par C genes were detected in 17 and 12 strains,respectively. One isolate harbored qnr B gene; no qep A gene was found. Seven isolates harbored aac（ 6＇）-Ib gene,but no aac（ 6＇）-Ib-cr mutation was detected. Conclusion A. baumannii is mostly isolated from inpatients indwelled urethral catheter. These strains are highly resistant to most of antimicrobial agents,treatment including urethral catheter removal and appropriate antibiotics resulted in good outcomes. The resistance to quinolones is mainly caused by mutation of gyr A or par C,and qnr B gene occurred in one isolate.

关 键 词：鲍曼不动杆菌 尿路感染 耐药性 喹诺酮耐药基因 

分 类 号：R378[医药卫生—病原生物学]