吴江地区多重耐药鲍曼不动杆菌碳青霉烯酶基因携带情况及同源性  

Carriage and homology of carbapenemase genes of multidrug-resistant Acinetobacter baumannii in Wujiang

作　　者：朱善军[1] 倪晓艳[1] 吴巧珍[1] 沈国荣[1] 陆静芬[1] 朱同华[1] 沈昊[1] 马春芳[1] ZHU Shan-jun NI Xiao-yan hua SHEN Hao MA Chun WU Qiao-zhen SHEN Guo-rong LU Jing-fen ZHU Tong- fang(Wujiang First People ＇s Hospital, Nantong University,Wujiang 215200, China)

机构地区：[1]南通大学附属吴江区第一人民医院,江苏吴江215200

出　　处：《中国感染控制杂志》2016年第12期913-916,933,共5页Chinese Journal of Infection Control

基　　金：吴江第一人民医院基金资助项目(201417)

摘　　要：目的了解吴江地区临床分离多重耐药鲍曼不动杆菌(MDRAB)碳青霉烯酶基因携带情况和同源性。方法收集吴江地区3所综合性医院2010年1月—2013年12月临床分离的非重复MDRAB 44株,测定其最低抑菌浓度(MIC);采用聚合酶链反应(PCR)扩增碳青霉烯酶基因OXA-51、OXA-23、OXA-24、OXA-58、IMP、TEM、SHV和GES,脉冲场凝胶电泳(PFGE)分析菌株同源性。结果 44株MDRAB主要来源标本为痰(占93.18%),主要分布在重症监护病房(ICU)、呼吸科和神经外科,各占45.45%、27.27%和13.64%;MDRAB对米诺环素和多粘菌素B均敏感,对哌拉西林、氨苄西林/舒巴坦、头孢他啶、庆大霉素、阿米卡星、环丙沙星耐药率均为100.00%,对亚胺培南和美罗培南耐药率均为97.73%。44株MDRAB均检出OXA-51、OXA-23和TEM基因,其中12株菌GES基因阳性,OXA-58和SHV基因阳性各1株,未检测到OXA-24及IMP基因;MDRAB分为A—G 7个型别,分别为19、3、9、3、1、4、5株。A型主要来源于吴江地区的两所大型综合性医院(吴江第一人民医院和盛泽医院),吴江第一人民医院未发现B、D和E型;E型仅1株,分布在永鼎医院,其余型别散在分布。结论吴江地区临床分离鲍曼不动杆菌多重耐药严重,基因OXA-23和TEM是鲍曼不动杆菌多重耐药的主要原因,并以A、C型为主,呈克隆性传播。Objective To investigate the carriage and homology of carbapenemase genes of multidrug-resistant Acinetobacterbaumannii （MDRAB）in Wujiang area.Methods A total of 44 non-duplicated MDRAB isolated from patients in 3 general hospitals in Wujiang area from January 2010 to December 2013 were collected. Minimum inhibitory concentrations （MICs）were detected,carbapenemase genes OXA-51,OXA-23,OXA-24,OXA-58, IMP,TEM,SHV,and GES were amplified with polymerase chain reaction（PCR）,homology of strains was detec-ted with pulsed-field gel electrophoresis （PFGE）.Results 44 MDRAB strains were mainly collected from sputum （93.18% ）,mainly distributed in intensive care unit （ICU）,department of respiratory diseases,and department of neurosurgery,accounting for 45.45% ,27.27% ,and 13.64% respectively;MDRAB were both sensitive to minocy-cline and polymyxin B,resistance rates to piperacillin,ampicillin/sulbactam,ceftazidime,gentamicin,amikacin, and ciprofloxacin were all 100.00% ,resistance rates to imipenem and meropenem were both 97.73% . 44 MDRAB strains were all detected OXA-51,OXA-23 and TEM genes,12 strains were positive for GES gene,1 strain was positive for OXA-58 and SHV respectively,OXA-24 and IMP genes were not found ;MDRAB were divided into 7 types of G-A,which included 19,3,9,3,1,4,and 5 strains respectively,type A was mainly from two large gen-eral hospitals in Wujiang area （Wujiang First People’s Hospital and Shengze Hospital）,type B,D and E strains were not detected in Wujiang First People’s Hospital,type E strain was only 1 isolate and was from Yongding Hos-pital,the other types were sporadically distributed.Conclusion Multidrug resistance of clinically isolated Acineto-bacterbaumannii is serious in Wujiang area,OXA-23 and TEM genes are major causes of multidrug resistance in Acinetobacterbaumannii,the main types are A and C,which present clonal spread.

关 键 词：鲍曼不动杆菌 碳青霉烯酶基因 多重耐药 脉冲场凝胶电泳 PFGE 

分 类 号：R181.32[医药卫生—流行病学] R378.99[医药卫生—公共卫生与预防医学]