安徽地区耐碳青霉烯鲍曼不动杆菌分子流行病学研究  

Molecular epidemiology study of carbapenem-resistant Acinetobacter baumannii in Anhui province

作　　者：刘舒雅 赵雷 叶英[1] Liu Shu-ya;Zhao Lei;Ye Ying(The First Affiliated Hospital of Anhui Medical University,Hefei 23002)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《中国抗生素杂志》2018年第9期1151-1155,共5页Chinese Journal of Antibiotics

基　　金：国家自然科学基金项目(No.81373072)

摘　　要：目的研究安徽地区耐碳青霉烯鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii, CRAB)的耐药性、碳青霉烯酶基因型及分子流行病学研究,为控制医院感染提供理论依据。方法收集安徽地区43家三级医院2015年9月和2016年9月CRAB非重复菌株312株,从中挑选出两年内均有CRAB的医院12家,菌株147株。对挑选出的147株CRAB采用琼脂稀释法测定16种抗菌药物的最低抑菌浓度(minimalinhibitoryconcentration,MIC);PCR扩增碳青霉烯酶耐药基因;采用多位点序列分型技术(multilocus sequence typing, MLST)进行分子分型,使用eBURST软件分析菌株亲缘性。结果 147株临床分离的CRAB均为多重耐药菌株,对16种抗菌药物耐药性均较高,其中对替加环素和米诺环素耐药性较低,分别为9.27%和54.26%。147株CRAB中有134株携带bla_(OXA-23)基因,1株携带bla_(OXA-24)基因,4株携带bla_(IMP)基因,全部携带bla_(OXA-51)基因,其余碳青霉稀类耐药基因均未检出。147株CRAB分为26个ST基因型,其中13个ST分型属于CC92克隆群,ST195有48株,为安徽地区最常见ST型,另外新发现15个ST基因型。结论本研究中安徽地区147株CRAB对临床常用抗生素耐药性严重,除替加环素和米诺环素外,耐药率均在76%以上。bla_(OXA-51)是位于染色体上的固有基因,检出率为100%;bla_(OXA-23)是安徽地区最主要的碳青霉烯酶基因型,检出率为91.15%。CC92为安徽地区最主要克隆群,与世界流行克隆群一致。本研究所测147株菌株间存在进化间关系,提示可能存在水平传播趋势。Objective To study the antimicrobial resistance, carbapenemase genotypes, and molecular epidemiology of Acinetobacter baumannii in Anhui province, in order to provide a theoretical basis for the control of hospital infections. Methods A total of 312 CRAB non-repeated strains were collected from 43 tier 3 level hospitals in Anhui province from September 2015 to 2016. Only 147 strains of non-repeated CRAB from 12 hospitals were selected in this study. The minimal inhibitory concentrations （MIC） of 16 antimicrobial agents against 147 Acinetobacter baumannii isolates were determined by the agar dilution method. Carbapenemase resistance genes were detected by PCR amplification.The genotype was identified by the multilocus sequence typing technique. Evolutionary diagram was generated with the eBURST software. Results Our results indicated that all the 16 antibiotics showed high resistance to the 147 A. baumannii isolates which were all multidrug resistant strains. Among the 16 antibiotics, TGC （9.27%） and MNO （54.26%） showed the lowest resistance. 143 CRAB strains were found to carry blaoxA_23 gene, one were found to carry blaoxA-24 gene, four were found to carry blaiMp gene. All the 147 CRAB strains were found to carry blaoxA-51 gene and other Carbapenemase genes were not found. The 147 strains of A. baumannii were divided into 26 ST genotypes, including 13 ST genotypes belonging to complex 92. ST195 had 48 strains, and was the main epidemiology type in Anhui province. 15 new ST genotypes were found. Conelusion In this study, 147 CRAB in Anhui province were seriously resistant to clinical antibiotics. Resistance rates were more than 76% except for MNO. blaoxA-51 is an innate gene that is located on chromosomes, and its detection rate was100%, blaoxA.23 was the main carbapenemase gene in Anhui province, and its detection rate was 91.15%. CC92 was the main clone group in Anhui province, which was consistent with the world＇s popular cloning group. There were phylogenetic relationships among the 147 strains,

关 键 词：鲍曼不动杆菌 耐药性 碳青霉烯酶基因 多位点序列分型 

分 类 号：R978.1[医药卫生—药品]