东莞地区临床分离耐碳青霉烯的鲍曼不动杆菌的耐药特点及其机制研究  

Study on genotyping of beta-lactamase in Carbapenem-resistant Acinetobacter baumannii separated in Dongguan area

作　　者：郭主声[1] 林偲思[1] 朱学海[1] 张丽[1] 张丽华[1] 胡继华[2] 周谋清 阎红霞[3] 郭少卿[4] Zhu-sheng Guo;Si-si Lin;Xue-hai Zhu;Li Zhang;Li-hua Zhang;Ji-hua Hu;Mou-qing Zhou;Hong-xia Yan;Shao-qing Guo(Clinical Laboratory,Tungwah Hospital Affiliated to Sun Yat-sen University,Dongguan, Guangdong 523110, China;Department of Infectious Diseases,Tungwah Hospital Affiliated to Sun Yat-sen University,Dongguan, Guangdong 523110, China;Department of Respiratory Medicine,Tungwah Hospital Affiliated to Sun Yat-sen University,Dongguan, Guangdong 523110, China;Emergency Department, Tungwah Hospital Affiliated to Sun Yat-sen University,Dongguan, Guangdong 523110, China)

机构地区：[1]中山大学附属东莞东华医院检验科,广东东莞523110 [2]中山大学附属东莞东华医院感染科,广东东莞523110 [3]中山大学附属东莞东华医院呼吸科,广东东莞523110 [4]中山大学附属东莞东华医院急诊科,广东东莞523110

出　　处：《中国现代医学杂志》2017年第20期34-39,共6页China Journal of Modern Medicine

摘　　要：目的回顾分析东莞东华医院2011~2013年临床分离的鲍曼不动杆菌的临床分布及耐药特点,为临床合理用药和防止医源性感染提供依据。方法选取2011~2013年东华医院临床分离的非重复鲍曼不动杆菌菌株30株,采用琼脂稀释法检测该菌对11种抗菌药物的最低抑菌浓度(MIC),采用乙二胺四乙酸纸片协同实验检测待检菌株的金属酶表型,采用三维实验检测待检菌株的Amp C酶表型和改良Hodge实验筛查碳青霉烯酶,聚合酶链反应进行OXA-23、OXA-24编码基因的检测,应用脉冲场凝胶电泳进行同源性分析。结果在监测的14种抗菌药物MIC中,耐药率>60%的达13种,其中只有头孢哌酮舒巴坦耐药率<50%,共筛选出耐碳青霉烯酶的鲍曼不动杆菌30株,其中金属酶表型和基因检测均为阴性,Amp C酶阳性者21株,改良Hodge实验阳性24株,其中26株OXA-23基因扩增阳性,未检出OXA-24基因,可见OXA-23基因为主要的流行克隆株。结论东莞地区临床分离的鲍曼不动杆菌多重耐药十分严重,产OXA-23碳青霉烯酶是鲍曼不动杆菌对碳青霉烯酶类药物耐药的重要机制,且碳青霉烯酶耐药菌株存在克隆流行。Objective To analyze clinical distribution and drug resistance of Acinetobacter baumannii isolated in Tungwah Hospital,to learnβ-lactamase gene of Acinetobacter baumannii resistant to Carbapenemso as to provide the basis for clinical use of drugs and prevention of nosocomial infections.Methods Thirtystrains of non-repetitive Acinetobacter baumannii resistant to Carbapenem which were isolated in TungwahHospital from January2011to December2013were collected.Agar dilution method was used to detect theminimal inhibitory concentrations(MIC)of11kinds of antimicrobial agents.Pidemiological analysis wasconducted.Carbapenemase was screened by modified Hodge test.The metalloenzyme phenotype and AmpCenzyme phenotype of the tested strains were detected by EDTA-disk synergy test and three-dimensional testrespectively.PCR amplification of OXA-23,OXA-24and pulsed field gel electrophoresis(PFGE)homologyanalysis were used to analyze the moleculer type and genetic relationship between the resistant strains.Results In the14antimicrobial agents with monitored MIC,the resistance rate of13species was over60%,only that of SCF was lower than50%.Totally30strains of Carbapenem-resistantwere Acinetobacter baumannii screened out,of which the metalloenzyme phenotype and gene were both negative,21strains had AmpCenzyme and24strains showed positive modified Hodge test;among which OXA-23gene was amplified in26strains while OXA-24gene was not detected.Conclusions The resistance of Acinetobacter baumannii isolatedin clinic of Dongguan area is very severe.OXA-23gene is the main carbapenemase gene,and Carbapenemresistantstrains are prevalent in this area.

关 键 词：鲍曼不动杆菌 耐碳青霉烯酶 药敏实验 耐药基因 

分 类 号：R446[医药卫生—诊断学]