摘要
目的了解医院ICU多药耐药鲍氏不动杆菌感染暴发的分子流行病学以及碳青酶烯类抗菌药物耐药的机制。方法收集2008年11月15日-12月9日ICU分离的非重复多药耐药鲍氏不动杆菌17株,使用微量稀释法测定抗菌药物的最低抑菌浓度(MIC);采用肠杆菌科基因间重复一致序列引物聚合酶链反应(ERIC-PCR)分型法对其进行分子流行病学研究;对多种水解碳青酶烯类抗菌药物的β-内酰胺酶基因进行聚合酶链反应(PCR)。结果 17株多药耐药鲍氏不动杆菌16株对亚胺培南耐药,对除阿米卡星、头孢哌酮/舒巴坦外的常用抗菌药物多药耐药;ERIC-PCR分型显示14株为A2型、1株A1型、2株A3型;15株检出OXA-23型β-内酰胺酶基因、未检出OXA-24型β-内酰胺酶基因,9株检出VIM型β-内酰胺酶基因8、株检出IMP型β-内酰胺酶基因。结论 ICU存在由同一类型的多药耐药鲍氏不动杆菌感染暴发流行;对亚胺培南耐药主要是OXA-23型丝氨酸β-内酰胺酶基因、VIM和IMP型金属β-内酰胺酶基因。
OBJECTIVE To investigate the outbreak of molecular epidemiology and the resistant mechanism of multi-resistant Acinetobacter baumannii(MRAB) to carbapenem antibiotics in ICU.METHODS A total of 17 non-repetitive strains of MRAB were collected from ICU from Nov 15th to Dec 9th,2008.Broth microdilution test was used to determine the minimal inhibitory concentration(MIC) of the antibiotics.The homology of 17 isolates of MRAB was determined by enterobacterial repetitive intergenic consensus(ERIC)-PCR.The OXA-23 and OXA-24 carbapenemases and VIM and IMP metalloenzyme genes were amplified.RESULTS Totally 16 isolates of MRAB were resistant to imipenem,all were multi-drug resistant to routine used antibiotics except amikacin and cefoperazone/sulbactam.Fourteen strains had the same profile(type A2),1 was type A1,2 were type A3.Fifteen isolates were OXA23 carbapenem gene positive and OXA24 type was not found.Eight isolates were IMP metalloenzyme genes positive.Nine isolates were VIM metalloenzyme genes positive.CONCLUSION The result shows that an outbreak of MRAB occurs in ICU and ERIC-PCR is a very useful tool for molecular epidemiology study.OXA23 carbapenemase and VIM and IMP metalloenzyme genes lead to the carbapenem-resistance.Effective infection control measures should be conducted in order to control the outbreak of MRAB.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2010年第18期2732-2734,共3页
Chinese Journal of Nosocomiology