重症监护病房医院感染耐碳青霉烯鲍曼不动杆菌耐药基因的研究与分析  

The study and analysis of drug resistance genes of nosocomial infection CRAB in ICU

作　　者：陈璐[1] 李凌竹[1] 冷应蓉[1] 查筑红[1] 程永素[1] 黄冰[1] 罗光英[1] 王敏[1] 江银辉[1] 

机构地区：[1]贵州医科大学附属医院感染管理科,贵州贵阳550004

出　　处：《中国药物应用与监测》2016年第1期52-55,共4页Chinese Journal of Drug Application and Monitoring

基　　金：贵州省科技计划项目(黔科合SY字2013-3176号)

摘　　要：目的:通过分析菌株耐药性和耐药基因检出情况,了解我院医院感染耐碳青霉烯鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)的流行病学特点,并探讨耐药机制,为临床合理选药提供参考。方法:筛选重症监护病房医院感染患者送检标本分离的CRAB,采用PCR扩增技术检测菌株是否携带OXA-23、TEM、SHV、VEB、CARB、DHA、VIM、IMP、PER、aac(3)-I、aac(6')-Ib、aph(3')-I、arm A、sul1和sul2基因。结果:53株医院感染CRAB对复方新诺明、妥布霉素较敏感,对其余13种抗菌药物耐药率均达50%以上,基因检出率依次为:TEM 100%,OXA-23 96.23%,arm A 90.57%,aac(6')-Ib22.64%,aac(3)-I 26.42%,aph(3')-I 73.58%,sul1 30.19%,sul2 56.60%,SHV 3.77%,VEB、CARB、DHA、IMP、VIM、PER未检出。共14组耐药基因检出与耐药情况完全相同的菌株。结论:我院医院感染CRAB的患者仍可考虑选用复方新诺明和妥布霉素进行治疗。我院定居并繁殖的CRAB耐β-内酰胺类抗菌药物的机制可能与TEM酶密切相关,携带OXA-23基因可能是耐碳青霉烯类抗菌药物的重要因素,检出率低的耐药基因可能在耐β-内酰胺类抗菌药物机制中的作用不大。我院不仅存在科室内部的交叉感染,而且存在科室之间的交叉感染,应加大力度做好感染控制工作。Objective： To analyze the situation ofantimicrobial resistance, related resistance genes and possible mechanism, and provide references for rational antimicrobial application and discover the epidemiologieal characteristics of CRAB in our hospital. Methods： PCR techniques were used to test OXA-23, TEM, SHV, VEB, CARB, DHA, VIM, IMP, PER, aac（3）-I, aac（6＇）-Ib, aph（3＇）-I, armA, sull and sul2 genes. Results： In addition to SMZ-TMP and tobramycin, resistant rate to 13 antibiotics were all over 50%. The detection rate of gene were TEM 100%, OXA-23 96,23%, armA 90.57%, aac（6＇）-Ib 22.64%, aac（3）-I 26.42%, aph（3＇）-I 73.58%, sull 30.19%, sul2 56.60% and SHV 3.77%. VEB, CARB, DHA, IMP, VIM and PER were not detected. There were 14 bacterial groups which had the same drug resistance and drug resistance gene. Conclusion： SMZ-TMP and tobramycin can be used to cure the CRAB infected patients. The TEM gene may be closely related to flolactams resistance. The OXA-23 may be a crucial factor for carbapenems resistance. Those genes with low detection rate may not play a big role in drug resistant mechanism. There are cross infection in the same department and among departments in our hospital, infection control should be strengthened.

关 键 词：耐碳青霉烯类鲍曼不动杆菌 耐药 耐药基因 医院感染 

分 类 号：R440[医药卫生—诊断学]