耐碳青霉烯类鲍氏不动杆菌的耐药基因检测及流行病学分析  

Drug resistance genes in carbapenem-resistant Acinetobacter baumannii and analysis of epidemiology

作　　者：宋志伟[1] 俞莲花[1] 蔡艳群[1] 潘晓[1] 郏伊范[1] 李宝青[2] 

机构地区：[1]台州市立医院检验科,浙江台州318000 [2]浙江省温州医科大学附属第二医院检验科,浙江温州325000

出　　处：《中华医院感染学杂志》2017年第2期255-258,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划项目(2011KYB05)

摘　　要：目的检测耐碳青霉烯类鲍氏不动杆菌(CRAB)的耐药基因,分析其流行情况。方法选择2015年6月-2016年6月临床分离的50株CRAB作为观察组,98株亚胺培南敏感(CSAB)菌株作为对照,进行同源性分析,及耐药基因检测。结果 CRAB对氨苄西林、哌拉西林耐药率较高,均>90.0%,对替加环素、环丙沙星相对敏感,耐药率为36.0%和32.0%;CRAB对哌拉西林、氨曲南、头孢唑林、头孢克洛、头孢他啶、头孢曲松、头孢噻肟钠、头孢吡肟、替加环素的耐药率均高于CSAB(P<0.05);50株CRAB主要分为6型,其中A型26株、B型6株、C型5株、D型7株、E型4株、G型2株,主要分布在ICU、呼吸内科和肿瘤科;CRAB AmpC、OXA-24和VIM-1基因检出率明显高于CSAB(P<0.05);CRAB的adeA、adeB和adeC基因检出率明显高于CSAB(P<0.05)。结论医院耐碳青霉烯类鲍氏不动杆菌耐药现象严重,存在着A型克隆株的播散流行,AmpC、OXA-24、VIM-1β-内酰胺酶耐药基因和adeA、adeB、adeC主动外排系统耐药基因可能是导致耐药的重要原因。OBJECTIVE To detect the drug resistance genes in carbapenem-resistant Acinetobacter baumannii （CRAB） and analyze the epidemiology. METHODS A total of 50 strains of CRAB were isolated from Jun 2015 to Jun 2016 and were chosen as the observation group, and 98 strains of carbapenem-sensitive A. baumannii （CSAB） were set as the control group. The homology was analyzed, and the drug resistance genes were detected. RESULTS The drug resistance rates of the CRAB strains to ampicillin and piperacillin were more than 90.0% the drug resistance rates to tigecycline and ciprofloxacin were 36. 0% and 32. 0%, respectively. The drug resistance rates to piperacillin, aztreonam, cefazolin, cefaclor, ceftazidime, ceftriaxone, cefotaxime, cefepime, and tigecycline were higher in the CRAB strains than in the CSAB strains （P〈0.05）. Totally 50 strains of CRAB were divided into 6 major types, including 26 strains of type A, 6 strains of type B, 5 strains of type C, 7 strains of type D, 4 strains of type E, and 2 strains of type G; the majority of the strains were isolated from ICU, respiratory medicine department, and oncology department. The detection rates of AmpC, OXA-24 and VIM-1 genes were significantly higher in the CRAB strains than in the CSAB strains （P〈0.05）; the detection rates of adeA, adeB, and adeC genes were significantly higher in the CRAB strains than in the CSAB strains （P 〈 0. 05）. CONCLUSION The CRAB strains are highly drug-resistant, the type A clonal strains are prevalent. The β-lactamase resistance genes such as AmpC, OXA-24, and VIM-1 as well as the active efflux system resistance genes like adeA, adeB, and adeC may be the leading causes of the drug resistance.

关 键 词：耐碳青霉烯类鲍氏不动杆菌 基因 流行病学 

分 类 号：R378[医药卫生—病原生物学]