鲍氏不动杆菌血流感染的临床分离株耐药性及毒力相关基因分布  

Drug resistance and virulence-related genes in clinical isolates of Acinetobacter baumannii causing bloodstream infection

作　　者：王婧婧 毛旭建 赵莹 杜强[2] 屠博文[2] 王凤鸣 黎俊宏[1,2] WANG Jing-jing;MAO Xu-jian;ZHAO Ying;DU Qiang;TU Bo-wen;WANG Feng-ming;LI Jun-hong(Nanjing Medical University,Nanjing,Jiangsu 21l166,China;不详)

机构地区：[1]南京医科大学公共卫生学院,江苏南京211166 [2]常州市疾病预防控制中心,江苏常州213022

出　　处：《中华医院感染学杂志》2024年第8期1121-1125,共5页Chinese Journal of Nosocomiology

基　　金：江苏省第六期"333工程"第三层次培养对象[(2022)3-4-163];常州市“十四五”卫生健康高层次人才培养工程(拔尖)(2022CZBJ099);常州市应用基础研究计划(中资助)(CJ20200105)。

摘　　要：目的探讨鲍氏不动杆菌血流感染的分离株耐药性及毒力相关基因分布差异。方法分析2018年1月-2021年12月从常州市疾病预防控制中心等数家合作医疗机构中检出的鲍氏不动杆菌的标本来源、感染科室分布及耐药状况;全自动微生物药敏分析仪做菌株鉴定、药敏试验,多位点序列分型探讨菌株克隆型,黏液拉丝试验鉴定菌株的毒力表型,聚合酶链式反应检测菌株毒力基因、荚膜血清型。结果鲍氏不动杆菌菌株主要来源于痰、伤口分泌物、血液标本;鲍氏不动杆菌菌株分布主要科室是重症监护病房(ICU)、创伤显微外科、神经外科;鲍氏不动杆菌菌株对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率比较高,具有多药耐药和广泛耐药性;鲍式不动杆菌菌株种包含15种ST型(牛津分型),主要为ST195,共检测出黏液丝试验阳性菌株22株(占比15.28%),共检出40株荚膜血清型(占比27.78%),菌株毒力基因主要为abaI、ompA、HemO、bap、CsuE、bfmS基因。结论鲍氏不动杆菌菌株主要来源于痰等标本,主要分布在ICU,其多药耐药及广泛耐药率均较高。鲍氏不动杆菌菌株以ST195型为主要流行菌株。鲍氏不动杆菌携带多种毒力基因,临床应严格防控重症监护病房中耐药高毒力鲍氏不动杆菌菌株的传播。OBJECTIVE To investigate the drug resistance and virulence related gene of Acinetobacter baumannii in bloodstream infection.METHODS The sources of sample,distribution of infection departments and drug resistance status of A.baumannii detected from several cooperative medical institutions such as Changzhou Center for Dis-ease Control and Prevention from Jan 2018 to Dec 2021 were analyzed.Fully automatic microbial drug sensitivity analysis instrument was used for strain identification and drug sensitivity testing.The clonal type of bacterial strains were explored through multilocus sequence typing.Virulence phenotype of strains was identified by mucus drawing test and virulence genes and capsule serotypes of strains were detected by polymerase chain reaction assay.RESULTS The strains of A.baumannii were mainly isolated from sputum,wound secretions,and blood samples.A.baumannii strains mainly distributed in the departments such as the intensive care unit(ICU),department of trauma microsurgery,and department of neurosurgery.The drug-resistant rates of A.baumannii strains to imi-penem,meropenem,and cefoperazone/sulbactam were relatively high,with multiple and widespread drug resist-ance.A.baumannii strains contained 15 ST types(Oxford typing),with the ST195 do.A total of 22 strains(15.28%)were detected as positive for mucus filament test,and 40 strains were capsule serotype(27.78%).The virulence genes of the strains were mainly abaI、omp A、HemO、bap、CsuE、bfmS genes.CONCLUSION A.bau-mannii strains are mainly derived from sputum and other specimens,mainly distributed in ICU,with high rates of multidrug resistance and widespread drug resistance.ST195 is the main epidemic strain of A.baumannii.A.bau-mannii carries a variety of virulence genes,and clinic control measures should be carried out to restrict the spread of drug-resistant high-virulence A.baumannii strains in intensive care units.

关 键 词：血流感染 鲍氏不动杆菌 毒力基因 耐药机制 耐药性 菌株分布 

分 类 号：R378[医药卫生—病原生物学]