CRAB的耐药性分析与OXA-51和OXA-23型碳氢酶烯酶检测在临床中的应用  

Drug resistance analysis of CRAB and clinical application of OXA-51 and OXA-23 hydrocarbon-enase detection

作　　者：刘喆[1] 弓晋林 LIU Zhe;GONG Jinlin(Department of Medical Technical Support,Western Medical Branch of PLA General Hospital,Beijing 100144,China)

机构地区：[1]解放军总医院京西医疗区医技保障科,北京100144

出　　处：《国际检验医学杂志》2024年第S02期99-102,共4页International Journal of Laboratory Medicine

摘　　要：目的分析该院分离的耐碳青霉烯酶鲍曼不动杆菌(CRAB)临床分布特点、耐药性以及blaOXA-51和blaOXA-23基因的携带情况,探讨CRAB耐药性与治疗策略,为临床合理使用抗菌药物提供依据。方法收集该院2020年3月至2021年3月期间79例疑似CRAB感染患者的临床资料,分别采用荧光定量PCR法(FQ-PCR)与质谱仪对菌株进行鉴定,用VITEKⅡ和纸片法检测CRAB对11种抗菌药物的耐药率。结果79株CRAB菌株标本来源主要为痰(84.8%),感染者主要来自呼吸科病房(67.1%),其次为神经外科科和神经内科科,分别占12.7%和10.1%;79份标本有46株blaOXA-51基因阳性,有48株blaOXA-23基因阳性,有45株blaOXA-51和blaOXA-23基因均阳性。32株用培养法鉴定的鲍曼不动杆菌有30株亚胺培南为耐药,同时这些鲍曼不动杆菌表现为多重耐药,具体的耐药情况为:对头孢曲松、头孢吡肟、亚胺培南、环丙沙星、氨苄西林/舒巴坦和头孢他啶抗菌药物耐药率均高于80.0%,对头孢唑啉的耐药率高达100.0%。结论32株鲍曼不动杆菌有较高的耐药水平,提示该院鲍曼不动杆菌耐药情况严重,OXA-51和OXA-23均为主要的耐药基因型别,且两种基因型别混合感染的情况较严重。Objective To analyze the clinical distribution characteristics,drug resistance,and the carrying status of blaOXA-51 and blaOXA-23 genes in carbapenem resistant Acinetobacter baumannii(CRAB)isolated from the hospital,and to explore the resistance and treatment strategies of CRAB,providing a basis for the ra-tional use of antibiotics in clinical practice.Methods Clinical data of 79 patients suspected of CRAB infection in our hospital from March 2020 to March 2021 were collected.The strains were identified by fluorescence quantitative PCR(FQ-PCR)and mass spectrometer,respectively.The drug resistance rate of CRAB to 11 an-tibacterial drugs was detected by VITEK II and disk method.Results The main source of specimens of 79 CRAB strains was sputum(84.8%),and the infected patients were mainly from the respiratory ward(67.1%),followed by the Department of Neurosurgery and Department of Neuroendosurgery(12.7%and 10.1%,respectively).In 79 samples,46 strains were positive for blaOXA-51,48 strains were positive for blaOXA-23,and 45 strains were positive for both blaOXA-51 and blaOXA-23.Of the 32 strains of Acineto-bacter baumannii identified by culture method,30 strains were imipenem resistant,and these Acinetobacter Baumannii showed multiple drug resistance,the specific drug resistance rates were higher than 80.0%to ceftriaxone,cefepime,imipenem,ciprofloxacin,ampicillin/sulbactam and ceftazidime antibiotics,and the drug resistance rate was as high as 100.0%to cefazolim.Conclusion 32 strains of Acinetobacter baumannii have high drug resistance,indicating that the drug resistance of Acinetobacter baumannii in the hospital is serious,OXA-51 and OXA-23 are the main drug resistance genotypes,and the mixed infection of the two genotypes is more serious.

关 键 词：鲍曼不动杆菌 碳青霉烯酶 药敏试验 

分 类 号：R446[医药卫生—诊断学]