临床科室ICU碳青霉烯类耐药鲍曼不动杆菌的分子流行病学研究  

Study on molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in different ICUs

作　　者：郭静[1] 冯丽娜[1] 陈浩俊[1] 李从荣[1] Guo Jing;Feng Lina;Chen Haojun;Li Congrong(Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China)

机构地区：[1]武汉大学人民医院检验科

出　　处：《中华危重症医学杂志（电子版）》2019年第2期91-97,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：国家重点临床专科建设项目(财社[2010]305)

摘　　要：目的探讨武汉大学人民医院各临床科室ICU内的碳青霉烯类耐药鲍曼不动杆菌(CRAB)的分子流行病学情况。方法收集本院2017年3月至2018年2月期间的CRAB,应用多位点序列分型(MLST)进行同源性分析;采用PCR检测消毒剂耐药基因qac△E1表达情况;同时,检测各ICU中CRAB对含氯消毒泡腾片、苯扎溴铵(BB)和葡萄糖酸氯己定(CLX)三种常用消毒液的MIC值。结果82株CRAB分为8个序列型,它们分别是ST540(36.58%,30/82),ST195(21.95%,18/82),ST208(18.29%,15/82),ST191(13.41%,11/82),ST369(4.88%,4/82),ST469(2.44%,2/82),ST381(1.22%,1/82)和ST136(1.22%,1/82),未发现新的序列型;且所有序列型均属于克隆复合体92(CC92)。qac△E1基因的阳性率为76.83%(63/82);qac△E1基因阳性分离株与阴性分离株对BB、CLX的MIC值分布的比较,差异均无统计学意义(H= 0.413,P= 0.680;H= 0.662,P= 0.508)。82株CRAB对含氯消毒泡腾片的MIC值均为250 mg/L,对BB的MIC值范围是32 ~ 128 mg/L,对CLX的MIC值范围是0.001 9%~ 0.007 8%。其中,41株(50%)CRAB菌株对BB和CLX的MIC值为64 mg/L和0.003 9%;2株(2.43%)CRAB对BB的MIC值为128 mg/L,24株(29.26%)CRAB对CLX的MIC值为0.007 8%。且呼吸内科ICU、神经内科ICU、神经外科ICU、心血管外科ICU及重症医学科的分离株对BB和CLX的MIC值分布的比较,差异均无统计学意义(H = 1.680,P = 0.794;H = 1.341,P = 0.719)。结论我院各临床科室ICU中存在CC92的广泛流行,且CRAB对常用消毒剂的抗性通常高于敏感菌株。Objective To investigate the molecular epidemiology of carbapenem-resistant Acinetobacter baumannii (CRAB) in different ICUs of Renmin Hospital of Wuhan University. Methods The CRAB was collected from March 2017 to February 2018. The homology was tested by multi-site sequence typing (MLST);the disinfectant resistance gene qac △E1 was detected by PCR. The minimum inhibitory concentration (MIC) of chlorine tablets, benzalkonium bromide (BB) and chlorhexidine gluconate (CLX) on CRAB in different ICUs was determined and compared. Results Totally 82 strains of CRAB were divided into 8 sequence types (STs) containing ST540 (36.58%, 30/82), ST195 (21.95%, 18/82), ST208 (18.29%, 15/82), ST191(13.41%, 11/82), ST369 (4.88%, 4/82), ST469 (2.44%, 2/82), ST381 (1.22%, 1/82) and ST136 (1.22%, 1/82), and no new ST was found. All STs were found to be the clonal complex 92. The positive rate of qac△E1 gene was 76.83%(63/82);the MIC distribution of BB and CLX between qac△E1 genes of positive and negative isolates all showed no significant differences (H = 0.413, P = 0.680;H = 0.662, P = 0.508). The MIC of 82 strains of CRAB to chlorine tablets was 250 mg/L, that to BB ranged from 32 to 128 mg/L, and that to CLX ranged from 0.001 9% to 0.007 8%. The MIC of 41 strains (50%) of CRAB to BB and CLX was 64 mg/L and 0.003 9%, respectively, that of 2 strains (2.43%) of CRAB to BB was 128 mg/L, and that of 24 strains (29.26%) of CRAB to CLX was 0.007 8%. Meanwhile, the MIC distribution of BB and CLX in respiratory ICU, neurology ICU, neurosurgery ICU, cardiovascular surgery ICU and critical care medicine all showed no significant differences (H = 1.680, P = 0.794;H = 1.341, P = 0.719). Conclusion There is a widespread epidemic of the clonal complex 92 in ICUs in all departments of our hospital, and the CRAB is generally more resistant to common disinfectants than sensitive strains.

关 键 词：不动杆菌属 碳青霉烯类 抗药性 细菌 

分 类 号：R446.5[医药卫生—诊断学]