重症监护病房耐碳青霉烯鲍曼不动杆菌感染特点与同源性分析  

Infections and homology of carbapenem-resistant Acinetobacter baumannii in intensive care unit

作　　者：林佩贤[1] 黄宝添[2] 辜红妮[1] 黄靖宇[1] 许斐斐[1] 林伟青[1] Lin Peixian;Huang Baotian;Gu Hongni;Huang Jingyu;Xu Feifei;Lin Weiqing(Department of Hospital Infection Management,the Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Radiation Oncology,Cancer Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院第二附属医院医院感染管理科,汕头515041 [2]汕头大学医学院附属肿瘤医院放疗科,汕头515041

出　　处：《国际流行病学传染病学杂志》2022年第6期408-412,共5页International Journal of Epidemiology and Infectious Disease

基　　金：广东省高水平大学重点学科建设"感染性疾病研究与防治"项目 (粤办函[2015]325号)。

摘　　要：目的了解重症监护病房(ICU)耐碳青霉烯鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)感染特点、耐药情况和同源性。方法以2020年7月至2021年6月汕头大学医学院第二附属医院ICU病区收治的检出鲍曼不动杆菌感染者为研究对象,按是否为CRAB感染分为病例组和对照组,比较两组的一般特征和用药情况。对CRAB菌株进行脉冲场凝胶电泳(PFGE)同源性分析,采用PCR检测耐药基因。结果共检出鲍曼不动杆菌感染者41例,其中病例组17例,对照组24例。病例组使用碳青霉烯类药物、抗菌药物使用时间≥10 d、检出菌为医院感染病原菌的比例分别为9/17、14/17和12/17,均高于对照组(χ^(2)=6.05、9.62和5.53,P均<0.05)。CRAB菌株对β内酰胺类、喹诺酮类、磺胺类的耐药/中介率均在80%以上。PFGE分型结果显示共检出9个型别,主要的耐药基因为ADC基因。结论ICU病区CRAB感染多见于医院感染病例,对β内酰胺类、喹诺酮类、磺胺类的耐药率较高,主要携带ADC耐药基因。Objective To explore the infection,drug resistance and homology of carbapenem-resistant Acinetobacter baumannii(CRAB)in intensive care unit(ICU).Methods According to whether they were infected with CRAB,the patients infected with Acinetobacter baumannii in ICU of the Second Affiliated Hospital of Shantou University Medical College were divided into case group and control group.The clinical characteristics and drug application were compared between two groups.The homology of CRAB strains was analyzed by pulsed field gel electrophoresis(PFGE),and the drug-resistance genes were detected by PCR.Results There were 41 cases infected with Acinetobacter baumannii,including 17 cases in case group and 24 cases in control group.The proportions of use of carbapenem drugs,antibiotic application for more than 10 days and nosocomial infections in case group were 9/17,14/17 and 12/17,respectively,which were significantly higher than those in control group(χ^(2)=6.05,9.62 and 5.53,P all<0.05).The drug resistance/intermediary rates of CRAB strains toβ-lactams,quinolones and sulfonamides were more than 80%.A total of 9 PFGE types were obtained from CRAB strains,and the main drug resistance gene was ADC gene.Conclusions CRAB strains are common in nosocomial infections in the ICU,and are highly resistant toβ-lactams,quinolones and sulfonamides with the main drug resistance gene of ADC.

关 键 词：鲍氏不动杆菌 重症监护室 同源性分析 耐药 基因 

分 类 号：R459.7[医药卫生—急诊医学]