耐碳青霉烯药鲍曼不动杆菌耐药性及相关耐药基因研究  

A study on drug resistant of carbapenem-resistant Acinetobacter baumannii and related drug resistant genes

作　　者：崔颖鹏[1] 冯冰 彭雅琴 黄汉[1] 伍众文[1] 廖康[1] CUI Yingpeng;FENG Bing;PENG Yaqing;HUANG Han;WU Zhongwen;LIAO Kang(Department of Laboratory Medicine,the First Affiliated Hospital of Sun-Yat Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院医学检验科,广州510080

出　　处：《实用医学杂志》2021年第19期2513-2517,共5页The Journal of Practical Medicine

摘　　要：目的了解临床分离出的对亚胺培南和美罗培南耐药的96株鲍曼不动杆菌耐药基因及耐药敏感性情况。方法对临床分离的96株碳青霉烯类耐药鲍曼不动杆菌进行碳青霉烯酶表型分析,PCR扩增耐药基因及电泳成像分析,药敏试验分析该菌对哌拉西林/他唑巴坦等15种药物的敏感情况。结果标本主要来源:下呼吸道59株(61.5%),静脉血18株(18.75%),引流液8株(8.3%);主要科室:ICU科室75株(78%),康复医学科5株(5.2%),神经科5株(5.2%);改良Hodge试验阳性菌株69株(71.9%);酶抑制试验显示与表型不相符,存在复合耐药机制;该菌对替卡西林/克拉维酸、哌拉西林/他唑巴坦和环丙沙星的耐药水平达100%,对其余药物如复方新诺明、头孢吡肟、妥布霉素、头孢哌酮/舒巴坦、左旋氧氟沙星、多西环素、头孢他啶耐药水平分别为83.3%、85.4%、88.4%、91.7%、96.9%、98.9%、99.0%,对多粘菌素耐药率为1.1%,替加环素耐药率为4.2%,米诺环素耐药率为36.8%;检出耐药基因OXA-2395株,OXA-5193株,KPC 3株,其余耐药基因未检出。结论碳青霉类耐药鲍曼不动杆菌表现多重耐药及泛耐药现象,OXA-23、OXA-51基因为该院临床碳青霉烯酶主要耐药基因。Objective strains of Acinetobacter baumannii resistant to imipenem and meropenem.Methods analysis was performed on 96 clinically isolated strains of carbapenem-resistant Acinetobacter baumannii,PCR amplification and electrophoresis imaging analysis of drug-resistant genes were performed,and drug sensitivity tests were conducted to analyze the sensitivity of the isolates to piperacillin/tazobactam and other 15 drugs.Results The samples were mainly obtained from lower respiratory tract(59 strains,61.5%),venous blood(18,18.75%),and drainage fluid(8,8.3%)and from ICU(75 strains,78%),rehabilitation medicine department(5,5.2%),and neurology department(5,5.2%).69 strains(approximately 71.9%)were positive in modified Hodge test.The enzyme inhibition test was not consistent with phenotype,and there was compound resistance mechanism.The bacteria was 100% resistance to ticacillin/clavulanate,piperacillin/tazobactam and ciprofloxacin;and 83.3%to cotrimoxazole,85.4% to cefepime,88.4% to tobramycin,91.7% to cefoperazone/sulbactam,96.9% to levofloxacin,98.9% to doxycycline,99.0%to ceftazidime,1.1%to polymyxin,4.2% to tegacycline,and 36.8%to minocycline.Drug resistance gene OXA-23 was detectable in 95 strains,OXA-51 in 93 and KPC in 3,while other resistant genes were not found.Conclusions and pan-drug resistance.OXA-23 and OXA-51 genes were the main drug resistance genes of carbapenemase in our hospital.

关 键 词：鲍曼不动杆菌 碳青霉烯酶 药物敏感性 耐药基因 

分 类 号：R446.1[医药卫生—诊断学]