RICU重症感染患者多药耐药鲍氏不动杆菌耐药基因及同源性  

Drug resistance genes and homology of multidrug-resistant Acinetobacter baumannii in patients with severe infection in RICU

作　　者：林石宁 王发辉[1] 石慧芳[1] LIN Shi-ning;WANG Fa-hui;SHI Hui-fang(The Second Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院呼吸内科,海南海口570311

出　　处：《中华医院感染学杂志》2022年第11期1601-1605,共5页Chinese Journal of Nosocomiology

基　　金：海南省医药卫生科研基金资助项目(20A200310)。

摘　　要：目的分析呼吸重症监护病房(RICU)重症感染多药耐药鲍氏不动杆菌(MDR-AB)耐药基因及同源性。方法选取2019年10月—2020年10月海南医学院第二附属医院RICU 100例鲍氏不动杆菌(AB)感染患者,对其分离的MDR-AB菌株进行细菌鉴定、药敏试验,应用聚合酶链式反应(PCR)扩增MDR-AB中耐药基因并进行Blast比对,采用肠杆菌科基因间重复序列-聚合酶链式反应(ERIC-PCR)分析其同源性。结果100例患者分离出MDR-AB 40株,MDR-AB主要来自痰液及咽拭子标本(82.50%),其次为尿液标本(10.00%);分离得到的40株MDR-AB菌株对哌拉西林、头孢他啶、氨苄西林/舒巴坦、美罗培南、头孢曲松、庆大霉素等12种药物均耐药,耐药率均为100%,对环丙沙星、阿米卡星、磺胺甲噁唑/甲氧苄啶、四环素耐药率分别为77.50%、60.00%、70.00%、65.00%,对左氧氟沙星、米诺环素、多黏菌素E、多黏菌素B均敏感;MDR-AB的主要基因有TEM、AmpC、OXA-23、OXA-51等,Blast比对结果显示,gyrA、parC存在基因突变;同源性分析发现,MDR-AB基因分型分为A、B、C、D、E型共5型,A、C型为主要流行克隆株。结论RICU重症感染MDR-AB的患者对部分抗菌药物耐药率处于较高水平,需加强抗菌药物合理使用,且TEM、AmpC、OXA-23、OXA-51为其主要耐药基因,菌株呈现高度同源,可能在科室内存在克隆与传播,需进一步完善相关防控措施。OBJECTIVE To analyze the drug resistance genes and homology of multidrug resistant Acinetobacter baumannii(MDR-AB)in patients with severe infection in the respiratory intensive care unit(RICU).METHODS A total of 100 patients with AB infection in the RICU of the Second Affiliated Hospital of Hainan Medical College from Oct.2019 to Oct.2020 were selected.Bacterial identification and drug sensitivity test were carried out on the isolated MDR-AB strains.The polymerase chain reaction(PCR)method was used to amplify drug resistance genes in MDR-AB and Blast aligning was performed.The homology was analyzed by enterobacterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR).RESULTS A total of 40 strains of MDR-AB were isolated from 100 patients.MDR-AB was mainly isolated from sputum specimens and throat swabs(82.50%),followed by urine specimens(10.00%).The 40 isolated MDR-AB strains were resistant to 12 drugs including piperacillin,ceftazidime,ampicillin/sulbactam,meropenem,ceftriaxone,and gentamicin,with resistance rates of 100%.The resistance rates to ciprofloxacin,amikacin,sulfamethoxazole/trimethoprim and tetracycline were 77.50%,60.00%,70.00%,and 65.00%,respectively.The strains were all sensitive to levofloxacin,minocycline,polymyxin E,and polymyxin B.TEM,AmpC,OXA-23,and OXA-51,etc were main drug resistance genes of MDR-AB.The results of Blast aligning showed that there are gene mutations in gyrA and parC.Homology analysis found that MDR-AB genotypes included A,B,C,D,and E 5 types,with type A and type C as main epidemic clonal strains.CONCLUSION Patients with severe infection induced by MDR-AB in RICU are highly resistant to some antibacterial drugs,of which the rational use of antibiotics needs to be strengthened.TEM,AmpC,OXA-23,and OXA-51 are the main resistance genes,and the strains showed a high degree of homogeneity,which indicates that cloning and transmission may be existed in the department,therefore,relevant prevention and control measures should be further improved.

关 键 词：呼吸重症监护病房 重症感染 多药耐药鲍氏不动杆菌 耐药基因 同源性 

分 类 号：R378[医药卫生—病原生物学]