神经外科术后颅内感染患者分离鲍氏不动杆菌的耐药性及分子流行病学  

Drug resistance and molecular epidemiology of Acinetobacter baumannii isolated from neurosurgery department patients with postoperative intracranial infection

作　　者：尹彩霞 胡凯 黄海艳[2] 刘静兰[3] 伍仕敏 YIN Cai-xia;HUKai;HUANG Hai-yan;LIU Jing-lan;WU Shi-min(Changjiang Shipping General Hospital,Wuhan,Hubei 430010,China;不详)

机构地区：[1]长江航运总医院重症医学科,湖北武汉430010 [2]华中科技大学同济医学院附属协和医院重症医学科,湖北武汉430022 [3]宜昌市中心人民医院(三峡大学第一临床医学院)护理部,湖北宜昌443000 [4]长江航运总医院检验科,湖北武汉430010

出　　处：《中华医院感染学杂志》2022年第14期2146-2150,共5页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅科研基金资助项目(WJ2019M144)。

摘　　要：目的研究神经外科术后颅内感染(ICI)患者分离鲍氏不动杆菌(AB)的耐药性及分子流行病学特征。方法分别选取2019年3月-2021年4月长江航运总医院重症医学科神经外科脑脊液培养检出AB的ICI患者107例和非ICI患者102例为研究对象,采集两组临床资料,取ICI患者脑脊液进行细菌培养和药敏试验,同时采用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)技术分析AB的分子流行病学特征。结果ICI组年龄和糖尿病占比均高于非ICI组(P<0.05),107例ICI患者共检出107株AB菌株,且对常用抗菌药物均存在不同程度耐药性。PFGE显示107株AB分为7个克隆型,分别为A型91株、B型6株、C型4株、D型2株、E型2株、F型1株及G型1株。MLST分型结果显示107株AB可分为14个ST基因型,其中较为常见的基因型依次为ST208、ST195、ST75、ST92和ST1696,菌株数分别为64、17、9、5和3株,其他ST基因型均为1株。eBUST软件进行同源性分析显示,基因型ST75、ST92、ST136、ST138、ST195和ST208共97株(90.65%),均属于克隆复合体92(CC92)且仅gpi等位基因位点存在差异,其余10株菌株分属于8个ST基因型。结论神经外科术后ICI患者年龄较大且常合并糖尿病,AB菌群对现阶段常用抗菌药物均具有一定耐药性,且PFGE和MLST检测结果均显示存在优势克隆株流行。OBJECTIVE To observe the drug resistance and molecular epidemiology of Acinetobacter baumannii isolated from neurosurgery department patients with postoperative intracranial infection(ICI). METHODS From Mar 2019 to Apr 2021, a total of 107 ICI patients from whom A.baumannii strains were isolated from cerebrospinal fluid specimens and 102 patients without ICI who were treated in neurosurgery department of critical care medicine department of Changjiang Shipping General Hospital were enrolled in the study. The clinical data were collected from the two groups of patients, the cerebrospinal fluid specimens were collected from the ICI patients, the drug susceptibility testing was performed, and the molecular epidemiological characteristics of A.baumannii were analyzed by using pulsed field gel electrophoresis(PFGE) and multilocus sequence typing(MLST) technology. RESULTS The age and the proportion of patients with diabetes mellitus were significantly higher in the ICI group than in the non-ICI group(P<0.05). Totally 107 strains of A.baumannii were isolated from 107 patients with ICI and were resistant to commonly used antibiotics in various degree. PFGE showed that 107 strains of A.baumannii were divided into 7 clonotypes, 91 of which were type A, 6 were type B, 4 were type C, 2 were type D, 2 were type E, 1 was type F, and 1 was type G. The result of MLST indicated that 107 strains of A.baumannii could be divided into 14 ST genotypes, and the most common genotypes were as follows: ST208(64 strains), ST195(17 strains), ST75(9 strains), ST92(5 strains), ST1696(3 strains);the rest of ST genotypes were 1 strain for each. The homology analysis that was carried out by eBUST showed that there were 97(90.65%) strains of ST75, ST92, ST136, ST138, ST195 and ST208 genotype in total, all of them belonged to cloning complex 92(CC92), there was only difference in the gpi allele locus, and the remaining 10 strains belonged to 8 ST genotypes. CONCLUSION The neurosurgery department patients with postoperative ICI are old and usually

关 键 词：神经外科手术 颅内感染 鲍氏不动杆菌 耐药性 流行病学 

分 类 号：R619.3[医药卫生—外科学]