2013-2020年某医院多重耐药鲍曼不动杆菌的临床分布、耐药性及碳青霉烯酶基因检测  

Analysis of clinical distribution,drug resistance and carbapenemase gene of multi-drug resistant Acinetobacter baumannii in a hospital from 2013 to 2020

作　　者：糜晓梅 杨闻君 MI Xiaomei;YANG Wenjun(Department of Laboratory Medicine,Chongqing Municipal Red Cross Hospital/Jiangbei District People's Hospital,Chongqing 400020,China)

机构地区：[1]重庆市红十字会医院/江北区人民医院检验科,重庆400020

出　　处：《广东药科大学学报》2022年第1期37-42,共6页Journal of Guangdong Pharmaceutical University

摘　　要：目的分析多重耐药鲍曼不动杆菌(multi-drug resistant Acinetobacter baumannii,MDR-Ab)的临床分布、耐药性和碳青霉烯酶基因检测情况,为指导临床抗感染治疗提供依据。方法收集重庆市某医院2013-2020年临床分离的非重复MDR-Ab菌株1008株,利用DL-96全自动细菌测定系统进行菌株鉴定和药敏实验,参照2020版CLSI M100文件标准判断药敏结果,并通过WHONET 5.6软件对菌株的临床分布和耐药特征进行统计分析,利用PCR法检测4种常见碳青霉烯酶基因(bla_(OXA-51)、bla_(OXA-23)、bla_(OXA-24)和bla_(OXA-58))。结果1008株MDR-Ab菌株中痰液占84.2%,肺泡灌洗液占7.4%,分泌物占2.9%,中段尿占2.4%,血液占1.6%,其他占1.5%;患者年龄集中在71~90岁,其中81~90岁占32.7%,71~80岁占28.1%;主要分布的科室为重症医学科、呼吸内科、肿瘤科和神经外科。药敏结果显示,1008株MDR-Ab菌株对复方新诺明、左旋氧氟沙星和氨苄西林/舒巴坦的耐药率低于80%,对其他10种常见抗菌药物的耐药率均大于80%。bla_(OXA-51)、bla_(OXA-23)基因型的检出率分别为62.0%、71.9%,且以bla_(OXA-51)/bla_(OXA-23)基因型为主(59.5%),未检出bla_(OXA-24)和bla_(OXA-58)基因型。结论分离出的1008株MDR-Ab菌株临床分布广泛,对临床上常用的抗菌药物大多数呈高度耐药,产bla_(OXA-51)碳青霉烯酶是引起鲍曼不动杆菌对亚胺培南耐药的主要原因之一,应重视对MDR-Ab菌株的耐药性监测,制定合理有效的感染控制措施,合理使用广谱抗菌药物,最大限度阻止MDR-Ab菌株的播散。Objective To investigate the clinical distribution,drug resistance and carbapenemase gene of multi-drug resistant Acinetobacter baumannii(MDR-Ab),and provide a reference for clinical anti-infection treatment.Methods A total of 1008 non-repetitive MDR-Ab strains were collected from Chongqing Municipal Red Cross Hospital from 2013 to 2020 and analyzed for antimicrobial susceptibility by DL-96 automatic bacteria determination system according to the CLSI 2020 standard.The clinical distribution and drug susceptibility were analyzed by WHONET 5.6 software.PCR was used to detect carbapenemase genes(bla_(OXA-51),bla_(OXA-23),bla_(OXA-24)and bla_(OXA-58)).Results Among the 1008 strains of MDR-Ab,sputum accounted for 84.2%,alveolar lavage fluid accounted for 7.4%,secretion accounted for 2.9%,middle urine accounted for 2.4%,blood accounted for 1.6%,and others accounted for 1.5%.The age of patients was mainly 71 to 90 years old,of which 81 to 90 years old accounted for 32.7%and 71 to 80 years old accounted for 28.1%.The main departments were intensive care medicine,respiratory medicine,oncology and neurosurgery.The results of drug sensitivity showed that the drug resistance rates of 1008 MDR-Ab strains to compound sulfamethoxazole,levofloxacin and ampicillin/sulbactam were less than 80%,and the drug resistance rates to other 10 common antibiotics were more than 80%.The detection rates of bla_(OXA-51)and bla_(OXA-23)genotypes were 62.0%and 71.9%respectively,and the bla_(OXA-51)/bla_(OXA-23)genotypes were main(59.5%),and no bla_(OXA-24)and bla_(OXA-58)genotypes were detected.Conclusion The 1008 isolated MDR-Ab strains are widely distributed clinically and are highly resistant to most commonly used antibiotics.The production of bla_(OXA-51)carbapenem is one of the main reasons for the resistance of Acinetobacter baumannii to imipenem.We should pay attention to the drug resistance monitoring of MDR-Ab strains,formulate reasonable and effective infection control measures,and use broad-spectrum antibiotics reasonably.

关 键 词：多重耐药鲍曼不动杆菌 临床分布 抗菌药物 耐药性 碳青霉烯酶基因 

分 类 号：R378.99[医药卫生—病原生物学] R969.3[医药卫生—基础医学]