耐碳青霉烯类药物的鲍氏不动杆菌耐药机制研究  

Drug resistant mechanism of carbapenem-resistant Acinetobacter baumannii

作　　者：李晶[1,2] 王倩[1] 

机构地区：[1]中国医科大学附属第一医院检验科,辽宁沈阳110001 [2]中国医科大学附属第一医院鞍山医院检验科,辽宁鞍山114000

出　　处：《中华医院感染学杂志》2017年第3期484-486,490,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81271908)

摘　　要：目的研究耐碳青霉烯类药物的鲍氏不动杆菌(CRAB)产生丝氨酸蛋白酶(A类酶)、苯唑西林水解酶(D类酶)和金属酶的耐药基因类型,为治疗和控制CRAB感染提供参考依据。方法应用全自动微生物分析系统VITEK-2对2011年1月-2015年12月57株CRAB进行鉴定和药敏分析,应用聚合酶链反应(PCR)检测耐药基因blaOXA-51,blaOXA-23,blaOXA-24,blaOXA-58,blaPER-1,blaVIM,blaIMP。结果 57株CRAB主要来源于ICU 34株占59.5%,其次为神经外科11株占19.3%;血液标本中检出33株占58.0%,其次脑脊液中检出12株占21.0%,CRAB仅磺胺甲噁唑/甲氧苄啶敏感率达63.6%,其余药物敏感率均在40.0%以下,头孢菌素类和碳青霉烯类药物耐药率均为100.0%;57株CRAB中blaOXA-51、blaOXA-23和blaOXA-24检出率分别为100.0%、96.5%和12.3%,blaPER-1检出率为5.3%,5株同时携带blaOXA-23和blaOXA-24,3株同时携带blaOXA-23和blaPER-1;未发现携带blaOXA-58、blaVIM和blaIMP菌株。结论本地区CRAB耐药基因以blaOXA-23为主,部分菌株携带blaOXA-24和blaPER-1,且不同耐药基因之间已出现联合耐药,未发现携带金属酶基因菌株。OBJECTIVE To study the drug resistant genes of carbapenem-resistant Acinetobacter baumannii（CRAB）producing serine proteases（class A enzyme）,oxacillin hydrolases（class D enzyme）and metalloenzymes,so as to provide references for the treatment and control of CRAB infection.METHODS Identification and drug susceptibility analysis of 57 cases of CRAB strains from Jan.2011 to Dec.2015 were carried out by automatic microbial analysis system VITEK-2.Resistant genes of blaOXA-51,blaOXA-23,blaOXA-24,blaOXA-58,blaPER-1,blaVIM,and blaIMP were detected by polymerase chain reaction（PCR）.RESULTS Of the 57 strains of CRAB,34（59.5%）were isolated from ICUs,and 11（19.3%）were isolated from neurosurgery departments;33（58.0%）were isolated from blood specimens,and 12（21.0%）were isolated from cerebrospinal fluid specimens.The drug susceptibility rate of the CRAB strains to sulfamethoxazole-trimethoprim was as high as 63.6%,the drug susceptibility rates to the rest of drugs were less than 40.0%;the drug resistance rates to cephalosporins and carbapenems were 100.0%.The detection rates of blaOXA-51,blaOXA-23 and blaOXA-24 of the 57 CRAB strains were 100.0%,96.5% and 12.3%,respectively,the detection rate of blaPER-1was 5.3%,among them5 strains simultaneously carried blaOXA-23 and blaOXA-24,3strains simultaneously carried blaOXA-23 and blaPER-1,and no blaOXA-58,blaVIMand blaIMPstrains were found.CONCLUSIONThe CRAB resistant gene in this region is mainly blaOXA-23,some strains carried blaOXA-24 and blaPER-1,the joint resistance of different resistant genes has appeared,and no metallogenase gene was found.

关 键 词：鲍氏不动杆菌 基因 耐药 

分 类 号：R378[医药卫生—病原生物学]