医院重症监护室环境分离鲍氏不动杆菌携带耐药相关基因研究  

Related resistant genes carried by Acinetobacter baumannii strains isolated from the environment of intensive care unit(ICU)

作　　者：葛忆琳[1] 陈越火[1] 徐春华 王致 沈伟[1] 

机构地区：[1]上海市疾病预防控制中心 [2]奉贤区疾病预防控制中心,上海200336

出　　处：《中华医院感染学杂志》2017年第19期4344-4347,共4页Chinese Journal of Nosocomiology

基　　金：上海市卫生计划生育委员会课题(20114100)

摘　　要：目的分析重症监护室(ICU)环境分离鲍氏不动杆菌株携带多种耐药基因的相关性,探索鲍氏不动杆菌耐药机制及传播耐药基因的途径。方法采用基因扩增技术与药敏试验微量稀释法进行研究。结果选取2013年1-12月ICU环境标本分离鲍氏不动杆菌109株,其中多药耐药的菌株47株占43.12%,对氨基糖苷类抗菌药物(阿米卡星)耐药率最高达62.39%;对碳青霉烯类抗菌药物(亚胺培南、美罗培南)的耐药率为53.21%~55.96%;对头孢菌素类的耐药率为53.21%~55.04%;所有菌株对多粘菌素B敏感;外排泵基因adeB基因的表达与A类、C类、D类β-内酰胺酶Tem基因、ADC基因、OXA-23群OXA-51,66群基因、膜孔蛋白CarO基因、氨基糖苷类基因aph(3′)-Ι具有相关性,qacE⊿1-sul1基因的表达与氨基糖苷类基因aph(3′)-Ι、C类β-内酰胺酶ADC具有相关性,CarO基因的表达与D类β-内酰胺酶OXA-23群基因、氨基糖苷类基因aph(3′)-Ι、aac(6′)-Ⅰb、回旋拓普酶gyrA基因具有相关性。结论环境分离鲍氏不动杆菌携带多药耐药基因相关性分析显示鲍氏不动杆菌多药耐药基因传播途径外排泵介导可对常用抗菌药物产生多药耐药性,产生耐消毒剂基因,膜孔蛋白CarO高表达,也加速多药耐药的积累和播散。提示加强病区环境消毒与管理,是有效阻断医院ICU多药耐药不动杆菌传播的重要措施。OBJECTIVE Analysis of the correlations among the multidrug resistance genes carried by Acinetobacter baumannii strains isolated from the environment of intensive care unit（ICU）and exploring the resistance mechanisms and pathways of spreading resistance genes of A.baumannii.METHODS Gene amplification technology and microdilution susceptibility tests（MIC）were used.RESULTS A total of 109 strains of A.baumannii isolated from ICU environmental specimens from Jan.2013 to Dec.2013 were selected.Totally 47 strains were multidrug resistance strains,accounting for 43.12%,and the resistant rate to aminoglycoside antibiotics（amikacin）was62.39%,the resistance rates of carbapenem antibiotics（imipenem and meropenem）were 53.21%-55.96%,the resistant rates to cephalosporins was 53.21%-55.04%,and all the strains were susceptible to polymyxin B.The expression of adeBgene in efflux pump gene was correlated with class A,class C and class Dβ-lactamase Tem gene,ADCgene,OXA-23 group OXA-51,66 group gene,porin CarOgene,and aminoglycoside gene aph（3′）-Ι.The expression of qacE ⊿ 1-sul1 was correlated with aminoglycoside gene aph（3′）-Ιand C-typeβ-lactamase ADC.The expression of CarOgene was correlatied with D-typeβ-lactamase OXA-23 gene,aminoglycoside gene aph（3′）-Ι,aac（6′）-Ⅰb and gyrase/topucine gyrAgene.CONCLUSIONThe correlation analysis of multidrug resistance genes carried by A.baumannii isolated from environment showed that A.baumannii multidrug resistance gene transmission pathway efflux pump can generate multidrug resistance to commonly used antibiotics,produce disinfectant resistant gene,porin CarO high expression and accelerate the accumulation and spread of multidrug resistance.The results indicate that strengthening the disinfection and management of ward environment is an important way to block the spread of multidrug resistance Acinetobacter effectively in the hospital ICU.

关 键 词：鲍氏不动杆菌 耐药基因 相关性 

分 类 号：R446.5[医药卫生—诊断学]