多药耐药鲍氏不动杆菌耐药性与β-内酰胺酶相关基因的研究  

Drug resistance of multidrug-resistant Acinetobacter baumannii andβ-lactamases related genes

作　　者：高春艳[1] 戎建荣[2] 于培霞[2] 栗子洋[2] 樊卫平[1] 

机构地区：[1]山西医科大学微生物学与免疫学教研室,山西太原030001 [2]山西医学科学院山西大医院检验科,山西太原030032

出　　处：《中华医院感染学杂志》2016年第6期1216-1218,1222,共4页Chinese Journal of Nosocomiology

基　　金：山西省留学办科研基金资助项目(2010-14-94)

摘　　要：目的研究多药耐药鲍氏不动杆菌（MDRAB）的耐药性及其β-内酰胺酶相关基因,分析其对β-内酰胺类抗菌药物的耐药机制,为临床合理使用抗菌药物提供依据。方法收集山西大医院2013年9月-2014年3月临床感染性疾病患者的标本,应用VITEK-2鉴定所分离的菌株,并进行药物敏感性分析试验;采用K-B纸片扩散法检测超广谱β-内酰胺酶（ESBLs）,同时筛选产AmpC酶菌;应用PCR及序列分析的方法分析β-内酰胺酶基因。结果鉴定获取55株鲍氏不动杆菌,其中41株为MDRAB,其对β-内酰胺/β-内酰胺酶抑制剂（氨苄西林/舒巴坦、哌拉西林/他唑巴坦）的耐药率为87.8%~90.2%,对其余β-内酰胺类、氨基糖苷类和氟喹诺酮类抗菌药物的耐药率在85.4%~100.0%;41株MDRAB中27株检出ESBLs检出率为65.9%,30株筛查出AmpC酶检出率为73.2%;产ESBLs菌株中检出TEM基因25株,检出率为92.6%,产AmpC酶菌株中检出ampC基因8株,检出率为26.7%。结论山西大医院分离到的鲍氏不动杆菌具有多药耐药性,对β-内酰胺类药物的耐药性与TEM和ampC基因关系密切。OBJECTIVE To explore the drug resistance of multidrug-resistant Acinetobacter baumannii andβ-lactamases related genes and analyze the drug resistance mechanisms toβ-lactams so as to provide guidance for reasonable clinical use of antibiotics.METHODS The specimens were collected from the patients with clinical infectious diseases who were treated in Shanxi Dayi Hospital from Sep 2013 to Mar 2014,then the isolated strains were identified by using VITEK-2system,the drug susceptibility testing was performed,the extended-spectrumβ-lactamases（ESBLs）were detected by means of K-B disc diffusion method,the AmpC enzyme-producing strains were screened out,and theβ-lactamases genes were analyzed with the use of PCR and sequence analysis method.RESULTS Of 55 strains of A.baumannii,41 were the multidrug-resistant A.baumannii.The drug resistance rate of the multidrug-resistant A.baumannii toβ-lactams orβ-lactamases inhibitors（ampicillin-sulbactam,piperacillintazobactam）varied from 87.8%to 90.2%;the drug resistance rates to otherβ-lactams,aminoglycosides,and fluoroquinolones varied from 85.4%to 100.0%.Of the 41 strains of multidrug-resistant A.baumannii,27 ESBLsproducing strains were detected positive,with the positive rate of 65.9%.Totally 30 AmpC enzyme-producing strains were screened out,with the positive rate of 73.2%.The TEM gene was detected positive in 25ESBLs-producing strains,with the positive rate of 92.6%;the ampCgene was detected positive in 8AmpC enzyme-producing strains,with the positive rate of 26.7%.CONCLUSION A.baumannii strains isolated from Shanxi Dayi Hospital are multidrug-resistant,and the drug resistance toβ-lactams is closely associated with the TEM and ampC genes.

关 键 词：鲍氏不动杆菌 多药耐药 Β-内酰胺酶 基因 

分 类 号：R378.99[医药卫生—病原生物学]