医院获得性肺炎患者醋酸钙-鲍曼不动杆菌复合体的鉴定和耐药基因研究  

Identification and drug resistance genes study of Acinetobacter calcoaceticus-A. baumannii complex from patients with hospital acquired pneumonia

作　　者：黄育波[1] 张天托[1] 朱家馨[1] 郑文争[1] 吴文斌[1] 李惠[2] 彭宣宪[2] 

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510006

出　　处：《实用医学杂志》2015年第3期476-481,共6页The Journal of Practical Medicine

基　　金：中山大学交叉学科资助计划项目(编号:A01586)

摘　　要：目的:了解我院医院获得性肺炎患者下呼吸道分离的醋酸钙-鲍曼不动杆菌复合体的菌种鉴定方法和耐药性,探讨其耐药机制。方法:收集2009-2014年临床分离的醋酸钙-鲍曼不动杆菌复合体共318株,用K-B法进行药敏试验,用gyr B多重PCR法对其进行菌种鉴定,检测碳青霉烯酶及金属β-内酰胺酶耐药基因。结果:318株醋酸钙-鲍曼不动杆菌复合体鉴定为鲍曼不动杆菌298株、不动杆菌基因种型3为5株、不动杆菌基因种型13TU 8株。对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的不敏感率分别为78.0%、89%、92.1%。OXA型碳青霉烯酶基因OXA-51、OXA-23、OXA-24、OXA-58检出率分别为91.2%、65.7%、1.3%、3.8%;金属β-内酰胺酶基因IMP、VIM、GIM-1、SPM-1检出率分别为0.9%、34.6%、6.3%、0.9%;未检测到OXA-48、OXA-143、SIM-1、KPC、NDM-1等基因。结论:gyr B多重PCR法是一种快速、特异性高、可靠的鉴定鲍曼不动杆菌的方法。鲍曼不动杆菌对多种抗生素呈现高度耐药。我院鲍曼不动杆菌耐药性主要与OXA-23、VIM等耐药基因的表达有关。Objective To investigate the antibiotic resistance of Acinetobacter calcoaceticus-A, baumannii complex （Acb complex） from the patients with hospital acquired pneumonia. To explore the identification method to differentiate Acb complex, to detect the expression of Carbapenemase and metallo-β-lactamases （MBLs） genes in order to explore their resistance mechanisms. Methods A total of 318 clinical isolates of Acb complex were collected from The Third Affiliated Hospital of Sun Yat-sen University during Jan. 2009 to Mar. 2014. Antibiotic susceptibility testing was determined by K-B disk diffusion method. The identification of strains was carried out by gyrB multiplex PCR. Carbapenemase genes and MBLs genes （including IMP, VIM, GIM-1, SPM-1, NDM-1） were detected. Results 318 strains of Acb complex were identified as 298 Acinetobacter baumannii, five Acinetobacter Genomic Species 3, and eight Acinetobacter genomic species 13TU. Acb complex were hightly resistant to many antibiotics, including Imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. There non- susceptibility rates were 78.0%, 89%, 92.1%, respectively. OXA type carbapenemase genes, such as OXA-51, OXA-23, OXA-24 and OXA-58 detection rates were 91.2%, 65.7%, 1.3%, 3.8%, respectively; Among MBLs genes, IMP, VIM, GIM-1 and SPM-1 detection rates were 0.9%, 34.6%, 6.3%, 0.9% , respectively; However, there were no detection for OXA-48, OXA-143, SIM-1, KPC, NDM-1 genes. Conclusion gyrB multiplex PCR method is a rapid, high specificity and reliable method for the identification of Acb complex. Acinetobacter baumannii were highly resistant to multiple antibiotics. OXA-23 and VIM gene expression were the main reasons of resistance mechanism for Acinetobacter baumannii in our hospital.

关 键 词：医院获得性肺炎 醋酸钙-鲍曼不动杆菌复合体 鲍曼不动杆菌 碳青霉烯酶 金属酶 耐药 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]