碳青霉烯类耐药鲍氏不动杆菌3种分子分型方法的对比研究  

Three types of molecular typing methods for carbapenem-resistant Acinetobacter baumannii

作　　者：姚彬[1] 徐英春[2] 王瑶[2] 张琪[2] 习慧明 柳爱青 张委[4] 汪涓[1] YAO Bin;XU Ying-chun;WANG Yao;ZHANG Qi;XI Hui-ming;LIU Ai-qing;ZHANG Wei;WANG Juan(Beijing Haidian Hospital,Haidian Section of Peking University Third Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)医院感染管理科,北京100080 [2]北京协和医院检验科,北京100730 [3]南昌市第三医院呼吸内科,江西南昌330009 [4]北京市海淀医院(北京大学第三医院海淀院区)检验科,北京100080

出　　处：《中华医院感染学杂志》2018年第18期2725-2730,共6页Chinese Journal of Nosocomiology

基　　金：北京市海淀区科技发展计划基金资助项目(K20110067)

摘　　要：目的通过对碳青霉烯类耐药鲍氏不动杆菌进行3种分子流行病学调查方法的对比研究,了解脉冲场凝胶电泳(PFGE)、多位点序列分析(MLST)和多位点可变数目串联重复序列分析(MLVA)3种方法在对碳青霉烯类耐药鲍氏不动杆菌复合体的流行病学调查中的优缺点和分辨率。方法收集某三级医院2011-2012年分离自痰标本的碳青霉烯类耐药鲍氏不动杆菌复合体212株,采用PFGE、MLST和MLVA方法对其进行分子流行病学分析,运用Simpson相关系数(Simpson's index of diversity)和Wallace coefficient,对3种方法的分辨率和同质性进行比较。结果 212株碳青霉烯类耐药鲍氏不动杆菌复合体,其中149株获得PFGE可分析结果,200株获得MLST可分析结果,205株获得MLVA可分析性结果;PFGE结果显示,B型菌株为优势菌株(102株,占68.46%)。MLST分型结果显示,ST195占优势(60株,占30%),其次为ST208(43株,占21.5%)和ST643(33株,占16.5%)。MLVA分型结果显示,D型菌株占优势(151株,占73.66%),其次为N型菌株(8株,占3.9%),K、M、T、W型菌株并列第三(均为4株,各占1.95%)。优势菌株主要分布在ICU。PFGE、MLST、MLVA的Simpson相关系数(D值)分别为0.46、0.76、0.94。MLVA与MLST的Wallace coefficient值略高为0.76。结论 PFGE是区域内分析克隆时间和空间分布的重要工具,本研究中院内流行的碳青霉烯类耐药鲍氏不动杆菌主要来自于ICU;MLST可全球范围内开展抗菌药物抵抗菌株,以及新变异菌株的流行病学研究;MLVA数据可用于不同实验室之间的相互交换、整合与分析。MLVA的分辨率较高,MLVA与MLST的同质性较高。OBJECTIVE To compare the advantages,disadvantages and discriminatory power of three methods,namely pulse field gel electrophoresis（PFGE）,multilocus sequence typing（MLST）and multilocus variable number tandem repeat sequence analysis（MLVA）,in molecular epidemiological investigation of carbapenem-resistant Acinetobacter baumannii.METHODS A total of 212 strains of carbapenem-resistant A.baumannii were isolated from sputum specimens in a tertiary care hospital between 2011 and 2012,the molecular epidemiological survey was conducted for the strains by using PFGE,MLST and MLVA,and the discriminatory power and homogeneity were compared among the three kinds of methods with the use of Simpson′s index of diversity and Wallace coefficient.RESULTS Of the 212 strains of carbapenem-resistant A.baumannii,149 could be analyzed by PFGE,200 could be analyzed by MLST,and 205 could be analyzed by MLVA.The results obtained by PFGE showed that type B was the dominant strain（102 strains,accounting for 68.46%）.The results of MLST typing showed that ST195 was dominant（60 strains,accounting for 30%）,followed by ST208（43 strains,accounting for 21.5%）and ST643（33 strains,accounting for 16.5%）.The results of the MLVA typing indicated that type D was the predominant strain,（151 strains,accounting for 73.66%）,followed by type N strains（8 strains,accounting for 3.9%）,and the type K,M,T and W strains ranked the third place（4 strains of each type,accounting for 1.95%）.The predominant strains were prevalent in the ICU.The Simpson correlation coefficients（D values）of PFGE,MLST and MLVA were 0.46,0.76 and 0.94,respectively.The Wallace coefficients of MLVA and MLST were 0.76.CONCLUSIONPFGE is an important tool for analysis of clonal time and spatial distribution in the region,the carbapenem-resistant A.baumannii strains that are prevalent in the hospital are mainly isolated from the ICU.MLST can conduct worldwide epidemiological studies on antibiotic-resistant strains and novel mutant strains.MLVA data ca

关 键 词：鲍氏不动杆菌 脉冲场凝胶电泳 多位点序列分析 多位点可变数目串联重复序列分析 

分 类 号：R446.5[医药卫生—诊断学]