鲍氏不动杆菌致医院获得性肺炎多药耐药性与碳青霉烯酶及整合酶基因的相关性研究  

Research on correlation of multi-drug resistance with carbapenemase and integrase genes in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii

作　　者：徐莉娜 张冬惠 王红丽 董凤霞 霍凤玲 郑莉方 XU Li-na;ZHANG Dong-hui;WANG Hong-li;DONG Feng-xia;HUO Feng-ling;ZHENG Li-fang(Kaifeng People's Hospital,Kaifeng,Henan 475000,China)

机构地区：[1]河南省开封市人民医院呼吸科,河南开封475000 [2]河南省开封市人民医院急诊科,河南开封475000

出　　处：《中华医院感染学杂志》2019年第19期2890-2893,2915,共5页Chinese Journal of Nosocomiology

基　　金：河南省自然科学基金资助项目(20145909832)

摘　　要：目的探讨鲍氏不动杆菌所致医院获得性肺炎多药耐药性与碳青霉烯酶及整合酶基因的相关性,为鲍氏不动杆菌所致医院获得性肺炎的临床治疗提供参考。方法选取2017年1-12月于河南省开封市人民医院住院的鲍氏不动杆菌所致的医院获得性肺炎患者100例(检出鲍氏不动杆菌100株),对病原菌进行分离、培养及耐药性检测,采用改良Hodge试验检测碳青霉烯酶,乙二胺四乙酸(EDTA)协同实验检测β-内酰胺酶,聚合酶链式反应扩增和测序分析碳青霉烯酶和整合酶基因。结果鲍氏不动杆菌对头孢唑林完全耐药,对头孢呋辛耐药率为98.00%,对美罗培南耐药率为85.00%,对亚胺培南耐药率为57.00%,对环丙沙星耐药率为82.00%,对其他抗菌药物的耐药率高低不一;100株鲍氏不动杆菌中62株为多药耐药株占62.00%。多药耐药株改良Hodge试验62株阳性,阳性率为100.00%,非多药耐药株23株阳性,阳性率60.53%(23/38),阳性率比较差异有统计学意义(P<0.05);全部菌株EDTA协同实验均为阴性。多药耐药株中OXA-23、OXA-51、Int1基因检出率均为100.00%,非多药耐药株以上基因检出率为68.42%、57.89%、42.11%,差异有统计学意义(P<0.001);多药耐药株中OXA-58基因检出率为1.61%,非多药耐药株中未检出。多药耐药株整合酶基因扩增结果有24株I类整合酶阳性,阳性率为38.71%,非多药耐药株3株阳性,阳性率为7.89%,差异有统计学意义(P=0.001),Ⅱ类和Ⅲ类整合酶均未有检出。结论鲍氏不动杆菌所致医院获得性肺炎多药耐药现象严峻,OXA-23、OXA-51、Int1碳青霉烯酶基因型和I类整合酶基因与医院获得性肺炎患者检出的鲍氏不动杆菌多药耐药关系密切。OBJECTIVE To investigate the correlation of multidrug resistance with carbapenemase and integrase genes in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii,so as to provide reference for clinical treatment of hospital-acquired pneumonia in patients caused by A.baumannii.METHODS Totally 100 patients with hospital-acquired pneumonia caused by A.baumannii who were hospitalized in the Kaifeng People's Hospital from Jan.to Dec.2017 were selected,and 100strains of A.baumannii were detected.The pathogens were isolated and cultured,and the drug resistance of the pathogens was tested.Carbapenemases were detected by modified Hodge testing.Beta-lactamase was detected by EDTA collaborative testing.Carbapenemase and integrase genes were amplified by PCR and sequenced.RESULTS A.baumannii was completely resistant to cefazolin,the drug resistance rate were 98.00% to cefuroxime,the drug resistance rate was 85.00%to meropenem,the drug resistance rate was 57.00% to imipenem,the drug resistance rate was 82.00%to ciprofloxacin,and rates of resist-ance to other antimicrobial agents varied.62 strains were found to be multidrug-resistant strains,accounting for 62.00%.62 strains were found to be positive in modified Hodge multidrug resistance testing,and the positive rate was 100.00%.23 strains of non multidrug-resistant strains were positive,with a positive rate of 60.53%(23/38),and the difference in positive rate comparison was significant(P<0.05).All the strains were negative in EDTA collaborative testing.The detection rates of OXA-23,OXA-51and Int1genes in multidrug-resistant strains were 100.00%,the detection rates of OXA-23,OXA-51and Int1genes in non multidrug-resistant strains were 68.42%,57.89% and 42.11%,the difference was significant(P<0.05).The detection rate of OXA-58in multidrug-resistant strains was 1.61%,whereas it was not detected in non multidrug-resistant strains.The results of integrase gene amplification showed that 24 multidrug-resistant strains were integrase I positive,and the positive ra

关 键 词：鲍氏不动杆菌 医院获得性肺炎 多药耐药性 碳青霉烯酶 整合酶基因 

分 类 号：R563.1[医药卫生—呼吸系统]