碳青霉烯类抗菌药物耐药鲍氏不动杆菌分布和耐药基因检测  

Distribution of carbapenem-resistant Acinetobacter baumannii and detection of drug resistance genes

作　　者：张春玲[1] 陈慧红[1] 牛津[1] 郑蓓佳 周勇[1] 

机构地区：[1]台州市中心医院检验科,浙江台州318000

出　　处：《中华医院感染学杂志》2017年第1期24-27,共4页Chinese Journal of Nosocomiology

基　　金：浙江省台州市科技计划项目(091KY05)

摘　　要：目的分析医院耐碳青霉烯类抗菌药物的鲍氏不动杆菌(CRAB)的临床分布和耐药基因,指导临床合理用药,防止产碳青霉烯类鲍氏不动杆菌的发生及传播。方法收集2013年9月-2015年9月台州市中心医院住院患者送检标本中分离132株CRAB,统计CRAB临床分布,并进行耐药性分析;采用法国生物梅里埃公司Vitek-2compact全自动细菌鉴定/药敏分析仪进行体外药敏试验;采用PCR方法扩增碳青霉烯酶基因,分析耐药机制。结果 132株非重复性CRAB菌株中,临床科室分布排前4位依次为ICU、脑外科、急诊ICU和呼吸内科,分别占50.8%、12.9%、11.4%和6.8%;132株CRAB除对阿米卡星、替加环素、左氧氟沙星有一定的敏感性外,对其余抗菌药物耐药率均很高;所有菌株OXA-51-like基因阳性,120株OXA-23-like基因阳性,未发现OXA-24-like和OXA-58-like基因阳性菌株;金属酶基因IMP、VIM检测为阴性。结论 CRAB主要分布在ICU和脑外科等科室;OXA-51和OXA-23基因是鲍氏不动杆菌最主要的碳青霉烯酶基因型。OBJECTIVE To investigate the clinical distribution of carbapenem-resistant Acinetobacter baumannii （CRAB） and detect the drug resistance genes so as to provide guidance for reasonable clinical use of antibiotics and prevent the CRAB strains from emergence and spread. METHODS A total of 132 strains of CRAB were isolated from submitted specimens of the patients who were hospitalized Taizhou Central Hospital from Sep 2013 to Sep 2015. The clinical distribution of the CRAB strains was statistically analyzed, the drug resistance of the strains was analyzed, the in vitro drug susceptibility testing was carried out by using Vitek-2 copmact automatic bacteria identification/ drug susceptibility analysis system of BioMfirieux, France, the carbapenemase genes were amplified by PCR method, and the drug resistance mechanisms were observed. RESULTS O1 the 132 strains of non-repetitive CRAB isolated from the clinical departments, 50.8M were isolated from ICU, 12.9% from department of brain surgery, 11.4% from emergency ICU, 6.80%from department of respiratory medicine. The 132 strains of CRAB showed certain susceptibility to amikacin, tigecycline, and levofloxacin but were highly resistant to the rest of an- tibiotics. The OXA-51-like gene was detected positive in all of the strains, the OXA-23-like gene was positive in 120 strains, however, the OXA-24-llke and OXA-58-like genes were not detected~ the metalloenzyme genes IMP and VIM were detected negative. CONCLUSION The CRAB strains are mainly isolated from the ICU and depart- ment of brain surgery. The OXA-51 and OXA-23 genes are the predominant carbapenemase genotypes in the A. baumannii strains.

关 键 词：鲍氏不动杆菌 碳青霉烯酶 苯唑西林酶 

分 类 号：R378[医药卫生—病原生物学]