多耐鲍曼不动杆菌分子流行病学分析  

Molecular characterization of multi-drug-resistant Acinetobacter baumannii isolated from patients in a hospital in Yunnan

作　　者：谭红丽 程雪琴[2] 王勇[2,3] 黄艳梅[1] 刘炜 张丽娟[2] 

机构地区：[1]云南省第三人民医院,云南昆明650011 [2]中国疾病预防控制中心传染病预防控制所,北京102206 [3]新疆石河子大学,新疆石河子832003

出　　处：《疾病监测》2015年第1期8-13,共6页Disease Surveillance

基　　金：国家"十二五"传染病重大专项课题(No.2008ZX10004-008;2012ZX10004215);国家"973"基础研究项目(No.2010CB530206)~~

摘　　要：目的分析云南省第三人民医院鲍曼不动杆菌分离株耐药表型及耐药基因分子流行病学特征。方法2013年6-9月,分离该院不同重症监护室(ICU)院内感染患者鲍曼不动杆菌28株,全自动微生物分析仪分类鉴定及耐药分析。PCR扩增及测序β-内酰胺酶、氟喹诺酮类及氨基糖苷类等抗性基因及IS插入元件及整合子等。结果 78.6%菌株为多药耐药菌,14.3%菌株为广泛耐药菌,7.1%的菌株为泛耐药菌。100%菌株不仅对一代/二代头孢类抗生素耐药,且对三代/四代抗生素CRO、CAZ、FEP及单环β-内酰胺类(ATM)、氟喹诺酮类(CIP、LEV)、氨基糖苷类(AN)及磺胺类(FD)耐药。特别是92.9%菌株对碳青霉烯类抗生素耐药。质粒介导的D类β-内酰胺类抗性基因blaOXA、氟喹诺酮类[aac(6’)-Ib-cr、qnr A及qnr D]及氨基糖苷类(aac A4、aad A1及aac C2)为主要基因型。100%菌株复合携带blaOXA、aac(6’)-Ib-cr及aac A4等抗性基因及整合酶int 1基因。85.7%菌株携带ISCR1。全部菌株为同一脉冲场凝胶电泳(PFGE)克隆群,且多位点序列分型(MLST)优势基因型为ST2。结论云南昆明第三人民医院ICU病房可能存在ST2多耐产碳青霉烯酶A.baumanni院内感染流行,有必要进行进一步流行病学及临床深入调查。防控措施及合理使用抗生素是当地医院当务之急。Objective To analyze phenotypes and genotypes of Acinetobacter baumannii isolated from ICU patients in a hospital in Kunming, Yunnan province. Methods A total of 28 A. baumannii strains were isolated from the patients in this hospital, and the strains were identified and their susceptibilities to 21 antibiotics were tested by using the bioMe＇rieux VITEK-2 system. PCR screening and sequencing was performed to identify β-1actamase genes, fluoroquinolone resistance related genes, aminoglycoside resistance related genes and gene capturing elements. Pulsed-field gel electrophoresis （PFGE） and multilocus sequence typing （MLST） were conducted to analyze the genetic relationships among the isolates. Results Among the strains isolated, 78.6% were MDR, 14. 3% were XDR and 7. 1% were PDR. All the isolates were resistant not only to 1^st and 2^nd generation cephalosporins and most 3^rd and 4^th generation cephalosporins （ceftriaxone, ceftazidime and cefepime ）, but also to monobactams （aztreonam）, quinolones （ciprofloxacin and levofloxacin ）, aminoglycosides （kanamycin） and nitrofurantoin （furadantin）. All the isolates co-carried blaoxA genes, quinolone resistance related gene-aac（6＇）-Ib-cr, aminoglycosides resistance related gene-aacA4 and gene capturing element-int 1. Phylogenetic analyses by PFGE revealed that all the isolates were in one clad. Conclusion MDR A. baumannii possessing blaoxA, aac （6＇）-Ib-cr, and aacA4 might circulate in this hospital, it is necessary to conduct further clinical and epidemiological survey, take effective control measures and use antibiotics rationally.

关 键 词：鲍曼不动杆菌 多重耐药 耐药基因 分子流行病学 

分 类 号：R446.5[医药卫生—诊断学]