上海市7家医疗机构ICU环境中鲍氏不动杆菌分布及耐药特征  

Distribution and drug resistance of Acinetobacter baumannii in ICU of seven medical institutions in Shanghai

作　　者：王筱 尤舒琪 许统圣 严依雯 丰俊 张红芝[3] 王远萍[1,2] 赵冰 WANG Xiao;YOU Shu-qi;XU Tong-sheng;YAN Yi-wen;FENG Jun;ZHANG Hong-zhi;WANG Yuan-ping;ZHAO Bing(Shanghai Pudong New Area Center for Disease Control and Prevention,Shanghai 200136,China;不详)

机构地区：[1]上海市浦东新区疾病预防控制中心,上海200136 [2]复旦大学浦东预防医学研究院,上海200136 [3]上海市疾病预防控制中心,上海200336

出　　处：《中华医院感染学杂志》2024年第16期2514-2519,共6页Chinese Journal of Nosocomiology

基　　金：上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科(GWVI-11.1-02-传染病学);2024年度复旦大学浦东预防医学研究院专项科技项目(YJY-2024-10)。

摘　　要：目的 了解上海市部分医疗机构重症监护病房(ICU)环境中鲍氏不动杆菌的分布及耐药情况,探究耐药表型与耐药基因的相关性,为制定感染控制策略提供数据支持。方法 采用棉签涂抹法采集2019年1-12月7家医疗机构ICU环境样本,通过常规生化及质谱仪分离、鉴定菌株,微量肉汤稀释法进行药敏试验,通过全基因组测序获得菌株的耐药基因。结果 共采集1 680份ICU环境样本,其中药敏结果显示鲍氏不动杆菌广泛存在于7家医疗机构ICU的物体表面,总检出率为6.79%(114/1 680);患者直接接触的被褥表面占比最高,为12.28%(14/114);头孢他啶和环丙沙星耐药率最高,均为84.21%(96/114),多药耐药菌株占比85.96%(98/114);但替加环素耐药率为1.75%(2/114),多黏菌素B耐药率为0.88%(1/114);全基因组测序结果显示114株鲍氏不动杆菌共携带6类26种耐药基因,β-内酰胺类携带率最高,为99.12%(113/114),未携带喹诺酮类耐药基因;二元Logistic回归分析结果显示bla_(OXA-23)、bla_(OXA-66)、aph(3″)-Ib、aph(6)-Id、armA、sul1、sul2、bla_(TEM-1D)耐药基因与其各自相关的抗菌药物耐药均呈正相关(P<0.05),tet(B)耐药基因与替加环素无明显相关性。结论 鲍氏不动杆菌普遍存在于医疗机构ICU环境中,耐药现况严峻。bla_(OXA-23)、bla_(OXA-66)、aph(3″)-Ib、aph(6)-Id、armA、sul1、sul2、bla_(TEM-1D)是鲍氏不动杆菌产生抗菌药物耐药表型的主要耐药基因,四环素类和喹诺酮类抗菌药物耐药表型与基因型并不一致,耐药机制复杂。OBJECTIVE To study the distribution of Acinetobacter baumannii in the environment of intensive care unit(ICU)of medical institutions,and to analyze the correlation between drug resistant phenotypes and drug resistant genes,so as to provide data support for formulating infection control strategies.METHODS ICU environmental samples from 7 medical institutions were collected by cotton swab smear method from Jan 2019 to Dec 2019.The strains were identified by matter-assisted laser desorption ionization time-of-flight mass spectrometer.The drug susceptibility was tested by microbroth dilution method.Drug-resistant genes were obtained by whole genome sequencing.RESULTS A.baumanni widely existed on the enviromental surfaces of medical institutions.The total detection rate was 6.79%(114/1680),with the highest proportion of 12.28%(14/114)on surfaces of the mattress directly touched by patients.The drug resistance rates of ceftazidime and ciprofloxacin were the highest,both of which were 84.21%(96/114).The multi-drug resistance rate of 114 strains was 85.96%(98/114).The drug resistance rates to tigecycline and polymyxin B were 1.75%(2/114)and 0.88%(1/114),respectively.Whole genome sequencing results showed that ll4 strains of A.baumanni carried 6 classes of 26 kinds of drugresistant genes,and the highest carrying rate of β-lactam resistance genes was 99.12%(113/114),no quinolone resistance gene was carried.Multivariate logistic regression analysis showed that the resistant genes of bla_(oxa-23),bla_(oxA-66),aph(3")-Ib,aph(6)-Id,armA,sull,sul2 and bla TEMiD were all positively correlated with their respective antibiotic resistance(P<0.05).Tet(B)resistance gene had no significant correlation with tigecycline.CONCLUSION A.baumanneni is common in ICU environment of medical institutions,and the drug resistance situation is severe.bla_( oxA-23) bla_(oxA-66) aph(3")-Ib,aph(6)-Id,armA,sull,sul2 and bla TEMiD are the main drug resistance genes.Tetracycline and quinolone antibiotic resistance phenotypes and genotypes are inconsiste

关 键 词：ICU环境 鲍氏不动杆菌 耐药性 同源性分析 

分 类 号：R378[医药卫生—病原生物学]