我院重症医学科鲍曼不动杆菌耐药性及分子流行病学研究  

Study on Drug Resistance and Molecular Epidemiology of Acinetobacter baumannii in Intensive Care Unit of Our Hospital

作　　者：汤雪梅 黄海波 殷琳 王艺萍 杨福勋 TANG Xuemei;HUANG Haibo;YIN Lin;WANG Yiping;YANG Fuxun(Intensive Care Unit,Sichnan Academy of Medical Sciences/Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院/四川省人民医院重症医学科,成都610072

出　　处：《中国药房》2018年第18期2520-2524,共5页China Pharmacy

摘　　要：目的:明确我院重症医学科鲍曼不动杆菌的耐药规律及主要机制,为临床合理用药提供参考。方法:选择2015年1月-2016年12月我院重症医学科检出的鲍曼不动杆菌90株,采用二倍稀释法检测其对10种常用β-内酰胺类抗菌药物的耐药性,采用聚合酶链反应法检测其β-内酰胺酶基因。结果:90株鲍曼不动杆菌来自于痰液(46株,占51.11%)、脓液(13株,占14.44%)、血液(12株,占13.33%)等标本;对青霉素类及第三、四代头孢菌素类抗菌药物的耐药率较高(≥50%),对碳青霉烯类抗菌药物的耐药率相对较低(<30%),对含酶抑制剂复合制剂头孢哌酮/舒巴坦的耐药率最低(11.11%)。有68.89%的菌株检出了β-内酰胺酶基因,其中检出Amp C、CTX-M2、TEM-1、SHV-5、PER-1、OXA-23基因的菌株分别有42、8、30、20、48、12株,检出率分别为46.67%、8.89%、33.33%、22.22%、53.33%、13.33%。未检出上述基因菌株的半数抑菌浓度(MIC50)为1~256μg/m L;检出上述基因菌株的MIC50为2~1 024μg/m L。其中,检出1、2、3种上述基因的菌株分别有19、15、26株,其MIC50分别为2~512、2~1 024、4~1 024μg/m L。结论:我院重症医学科检出的鲍曼不动杆菌主要来自于痰液标本,对常用β-内酰胺类抗菌药物的耐药率普遍较高;检出的β-内酰胺酶基因以PER-1、Amp C为主,且检出的基因种类越多,菌株对β-内酰胺类抗菌药物的耐药率越高。临床应进一步检测鲍曼不动杆菌的同源性,做好院内环境消毒,加强该菌耐药性监测,加大抗菌药物临床使用管理力度,并根据药敏试验结果合理选用抗菌药物,以减少耐药鲍曼不动杆菌的产生。OBJECTIVE:To confirm the regularity of drug resistance and main mechanism of Acinetobacter baumannii in ICU of our hospital,and to provide reference for rational drug use in clinic.METHODS:Ninety strains of A.baumannii were collected from ICU of our hospital during Jan.2015-Dec.2016.Drug resistance of A.baumannii to 10 kinds of commonly usedβ-lactam antibiotics was determined by two-fold dilution method.The presence ofβ-lactamase genes was detected by PCR.RESULTS:Totally 90 strains of A.baumannii were separated from sputum specimen(46 strains,51.11%),purulent fluid specimen(13 strains,14.44%)and blood specimen(12 strains,13.33%),etc.The resistance rates of A.baumannii to penicillins,three or four-generation cephalosporins were in high level(≥50%),while that of it to carbapenems was in low level relatively(<30%),that of it to inhibitor compound preparation containing enzyme as cefoperazone/sulbactam was the lowest(11.11%).β-lactamase genes were detected in 68.89%of strains,and there were 42 strains of AmpC,8 strains of CTX-M2,30 strains of TEM-1,20 strains of SHV-5,48 strains of PER-1,12 strains of OXA-23 genes;detection rates of them were 46.67%,8.89%,33.33%,22.22%,53.33%,13.33%,respectively.MIC50 of strains without above genes were 1-256μg/mL,and MIC50 of strains with above genes were 2-1 024μg/mL.There were 19 strains with 1 kind of above genes,15 strains with 2 kinds of above genes,26 strains with 3 kinds of above genes;MIC50 of them were 2-512,2-1 024,4-1 024μg/mL,respectively.CONCLUSIONS:A.baumannii were mainly from sputum specimen in ICU of our hospital,and resistant rate of commonly usedβ-lactam antibiotics is in high level generally.β-lactamase genes were mainly PER-1 and AmpC;the more gene types,the higher resistant rate of strains toβ-lactam antibiotics.It is necessary to further detect the homlolgy of A.baumannii,conduct hospital environment disinfection,strengthen drug resistance monitoring,enhance clinical application management of antibiotics,and select antibiotics rationally according to

关 键 词：鲍曼不动杆菌 耐药性 Β-内酰胺类抗菌药物 Β-内酰胺酶基因 

分 类 号：R378[医药卫生—病原生物学]