重症监护病房碳青霉烯耐药鲍曼不动杆菌5种耐药基因检测及同源性研究  

Detection and homology study of five carbapenem-resistant genes in Acinetobacter baumannii from intensive care units

作　　者：陈丽[1] 薛娇 CHEN Li;XUE Jiao(Department of Clinical Laboratory,Wuhan Sixth Hospital,Hubei Province,Wuhan 430015,China)

机构地区：[1]武汉市第六医院检验科,湖北武汉430015

出　　处：《中国医药导报》2025年第2期35-39,共5页China Medical Herald

基　　金：武汉市卫生健康委员会科研项目(WX23Z86)。

摘　　要：目的探讨重症监护病房碳青霉烯耐药鲍曼不动杆菌(CRAB)碳青霉烯酶的基因型及同源性,为临床诊断和治疗、防治提供理论基础。方法收集武汉市第六医院2022年1月至12月重症监护病房支气管-肺泡灌洗液标本中分离的非重复CRAB 40株,利用VITEK 2 Compact系统,配合N533药物敏感性试验卡进行药敏试验,PCR检测5种常见碳青霉烯酶基因(bla OXA-23-like、bla OXA-24-like、bla OXA-48-like、bla OXA-51-like、bla OXA-58-like),多位点序列分型对菌株同源性进行分析。结果40株CRAB对替卡西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、亚胺培南、美罗培南等的耐药率为100%,而对黏菌素和替加环素的耐药率分别为5%和2.5%。40株CRAB菌株全部携带bla OXA-23-like和bla OXA-51-like基因,均未检出bla OXA-24-like、bla OXA-48-like和bla OXA-58-like基因。多位点序列分型得到7种序列类型(ST)型,分别为ST450型18株(45%)、ST208型6株(15%)、ST195型6株(15%)、ST369型4株(10%)、ST381型、ST191型和ST457型各2株(各占5%)。结论从武汉市第六医院重症监护病房分离出来的CRAB对临床常用抗菌药物具有严重的抗药性,携带bla OXA-23-like和bla OXA-51-like基因为主要耐药机制。流行的CRAB菌株以ST450型和ST208型为主,菌株之间存在同源相关性,临床医生应规范使用抗菌药物,并强化对细菌的耐药性监测及医院感染防控,以遏制耐药菌的进一步传播。Objective To investigate the genotype and homology of carbapenem-resistant Acinetobacter baumannii (CRAB) carbapenemase in the intensive care unit and to provide theoretical basis for clinical diagnosis, treatment, prevention, and treatment. Methods Forty non repetitive CRAB strains were collected from bronchoalveolar lavage fluid samples collected from the intensive care unit of Wuhan Sixth Hospital from January to December 2022. Drug susceptibility tests were conducted using the VITEK 2 Compact system in combination with the N533 drug susceptibility test card. PCR was used to detect five common carbapenemase genes (bla OXA-23 like, bla OXA-24 like, bla OXA-48 like, bla OXA-51 like, and bla OXA-58 like), and multilocus sequence typing was used to analyze the homology of the strains. Results The drug resistance rates of 40 CRAB strains to Ticacillin/clavulanate, Piperacillin/Tazobactam, Ceftazidime, Imipenem and Meropenem were 100%, while the drug resistance rates to colistin and tigacycline were 5% and 2.5%, respectively.. However, the resistance rates to Piperacillin, Ceftazidime, Cefepime, Ciprofloxacin, Piperacillin/Tazobactam, Imipenem, and Meropenem were 100%. All 40 CRAB strains carry bla OXA-23 like and bla OXA-51 like genes, and no bla OXA-24 like, bla OXA-48 like, or bla OXA-58 like genes were detected. Multilocus sequence typing resulted in seven sequence type (ST) types, including 18 strains (45%) of ST450 type, six strains (15%) of ST208 type, six strains (15%) of ST195 type, four strains (10%) of ST369 type, and two strains (5% each) of ST381, ST191, and ST457 types. Conclusion The CRAB strains isolated from the intensive care unit of Wuhan Sixth Hospital exhibit severe resistance to commonly used clinical antibiotics, carrying bla OXA-23 like and bla OXA-51 like genes as the main resistance mechanisms. The popular CRAB strains are mainly ST450 and ST208, and there is homologous correlation between strains. Clinicians should standardize the use of antibacterial drugs and strengthen the monitoring of

关 键 词：鲍曼不动杆菌 碳青霉烯酶耐药 耐药基因 多位点序列分型 

分 类 号：R446.5[医药卫生—诊断学]