ICU鲍氏不动杆菌qacEΔ1-sul1基因及消毒剂抗性分析  

qacEΔ1-sul1 gene in Acinetobacter baumannii isolated from ICU and resistance to disinfectants

作　　者：江冬萍[1] 顾成武[1] 惠亚 王洁[2] 李艳霞[1] 左素清 李虹[1] 王晓红[1] JIANG Dong-ping;GU Cheng-wu;HUI Ya;WANG Jie;LI Yan xia;ZUO Su-qing;LI Hong;WANG Xiao-hong(Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院医院感染管理科,四川遂宁629000 [2]遂宁市中心医院医院检验科,四川遂宁629000

出　　处：《中华医院感染学杂志》2020年第22期3384-3388,共5页Chinese Journal of Nosocomiology

基　　金：四川省预防医学会医院感染预防与控制基金资助项目(SCGK201803);四川省卫生和计划生育委员会科研基金资助项目(17PJ455)。

摘　　要：目的了解重症监护病房(ICU)内患者与环境分离的鲍氏不动杆菌(AB)耐消毒剂基因qacEΔ1-sul1携带情况及对含氯消毒剂的最低抑菌浓度(MIC)。方法检测2017年3月-2018年7月遂宁市中心医院ICU患者医院感染AB(患者组)及同期ICU环境及工作人员手分离AB(环境组)的药敏情况,采用聚合酶链式反应(PCR)检测AB qacEΔ1-sul1基因携带情况,微量肉汤稀释法测定MIC。结果患者组qacEΔ1-sul1基因携带率为77.27%(34/44),环境组为94.29%(33/35),差异有统计学意义(P<0.05);患者组和环境组耐药情况比较,头孢曲松、妥布霉素、庆大霉素、左氧氟沙星差异有统计学意义(P<0.05);两组携带耐消毒剂基因菌株耐药情况比较,除阿米卡星、头孢曲松外,其他各抗菌药物差异均有统计学意义(P<0.05);患者组和环境组MIC分布差异有统计学意义(P<0.05);两组携带耐消毒剂基因菌株MIC分布差异有统计学意义(P<0.05)。结论 ICU环境中检出的AB qacEΔ1-sul1基因携带率及对含氯消毒剂的MIC较高,患者体内检出的AB对抗菌药物耐药性较强,提示临床在规范使用抗菌药物的同时应合理使用消毒剂,避免产生交叉耐药的超级细菌。OBJECTIVE To understand the disinfectant-resistant gene qacEΔ1-sul1 in Acinetobacter baumannii isolated from patients and environment of intensive care unit(ICU) and observe the minimum inhibitory concentration(MIC) against chlorine containing disinfectants. METHODS From Mar 2017 to Jul 2018, the drug susceptibility rates of the A.baumannii strains isolated from the ICU patients with nosocomial infection( the patient group) and the A.baumannii strains isolated from environment and hands of working staff(the environment group) were observed, the qacEΔ1-sul1 in the A.baumannii was detected by using polymerase chain reaction(PCR), and the MIC was determined by means of broth microdilution method. RESULTS The carrying rate of qacEΔ1-sul1 was 77.27%(34/44) in the patients group, 94.29%(33/35) in the environment group, and there was significant difference(P<0.05). There were significant differences in the drug resistance rates to ceftriaxone, tobramycin, gentamycin and levofloxacin between the patient group and the environment group(P<0.05). There were significant differences in the drug resistance rates of the strains carrying disinfectant-resistant genes between the two groups except for amikacin and ceftriaxone(P<0.05). There were significant differences in the MICs between the patient group and the environment group(P<0.05). There were significant differences in the MICs between the two groups of strains carrying disinfectant-resistant gene(P<0.05). CONCLUSION The carrying rate of qacEΔ1-sul1 of the A.baumannii isolated from the environment is high, the MIC of the chlorine-containing disinfectant is high;the A.baumannii isolated from the patients are highly resistant to antibiotics. It is suggested that reasonable use of antibiotics and disinfectants may avoid the emergence of super bacteria with cross resistance.

关 键 词：重症监护病房 鲍氏不动杆菌 耐药性 耐消毒剂基因 最低抑菌浓度 

分 类 号：R378.99[医药卫生—病原生物学]