重症监护病房耐碳青霉烯鲍曼不动杆菌6种耐药基因检测  

Detection of six resistance genes of carbapenem-resistant Acinetobacter baumannii in ICU

作　　者：徐益 高辉[1] 王佳[1] 王杨[1] 彭传梅 姚瑶[1] 鲁祥辉 Xu Yi;Gao Hui;Wang Jia;Wang Yang;Peng Chuan-mei;Yao Yao;Lu Xiang-hui(Kunming Medical University Affiliated Yan'an Hospital/Yunnan Cardiovascular Hospital Laboratory,Kunming 650051)

机构地区：[1]昆明医科大学附属延安医院/云南心血管病医院检验科,昆明650051

出　　处：《中国抗生素杂志》2021年第1期72-75,共4页Chinese Journal of Antibiotics

基　　金：昆明医科大学研究生创新基金(No.2019S207)。

摘　　要：目的研究医院重症监护病房(intensive care unit,ICU)患者感染鲍曼不动杆菌的耐药性及耐药基因,以指导临床合理用药,控制ICU病房感染暴发流行。方法采用VITEK2-Compact全自动细菌鉴定药敏系统对细菌进行鉴定及药敏试验,用聚合酶链反应(polymerase chain reaction,PCR)方法检测6种常见碳青霉烯酶耐药基因(bla_(IMP)、bla_(VIM)、bla_(NDM)、bla_(OXA-23)、bla_(OXA-24)和bla_(OXA-58))。结果38株耐碳青霉烯鲍曼不动杆菌对15种临床常用青霉素类、头孢菌素类、氨基糖苷类、喹诺酮类及β-内酰胺酶抑制剂类抗菌药物全部耐药,对头孢哌酮/舒巴坦、米诺环素的耐药率分别为92.1%和81.6%,仅对替加环素保持较高敏感性,敏感率为94.7%。38株CRAB中携带blaOXA-23基因共36株(94.7%),未检出blaIMP、blaVIM、blaNDM、blaOXA-24和blaOXA-58基因。结论我院ICU分离耐碳青霉烯鲍曼不动杆菌对临床常用抗菌药物耐药广泛,携带blaOXA-23基因是可能该院ICU耐碳青霉烯鲍曼不动杆菌对碳青霉烯类抗菌药物耐药的主要原因。临床医生应合理使用抗菌药物,加强细菌耐药性监测,防止耐药菌株的产生和进一步传播。Objective To study the drug resistance and drug resistance genes of Acinetobacter baumannii in intensive care unit(ICU)in order to guide clinical rational drug use and control the outbreak of infections in ICU.Methods The VITEK2-compact automatic bacterial identification drug susceptibility system was used for the identification and susceptibility test of bacteria.The polymerase chain reaction(PCR)method was used to detect six common carbapenemase resistance genes(bla_(IMP),bla_(VIM),bla_(NDM),bla_(OXA-23),bla_(OXA-24) and bla_(OXA-58)).Results 38 strains of carbapenem-resistant Acinetobacter baumannii were all resistant to 15 common clinical antibiotics,including penicillins,cephalosporins,aminoglycosides,quinolones,andβ-lactamase inhibitors.The resistance rates of piperidone/sulbactam and minocycline were 92.1%and 81.6%,respectively,and they remained sensitive to tigecycline only,with a sensitivity rate of 94.7%.A total of 36(94.7%)blaOXA-23 genes were carried in 38 CRAB strains,and no blaIMP,blaVIM,blaNDM,blaOXA-24,and blaOXA-58 genes were detected.Conclusion Carbapenem-resistant Acinetobacter baumannii isolated from our hospital was widely resistant to commonly used antibiotics in the clinic.The main reason for carbapenem resistance of carbapenem-resistant Acinetobacter baumannii in ICU of our hospital maybe was the strains carrying the blaOXA-23 gene.Clinicians should use antibiotics reasonably,strengthen the monitoring of bacterial resistance,and prevent the production and further spread of drug-resistant strains.

关 键 词：耐碳青霉烯鲍曼不动杆菌 重症监护病房 耐药基因 

分 类 号：R978.1[医药卫生—药品]