耐亚胺培南鲍曼不动杆菌产碳青霉烯酶及耐药性变迁研究

A study of the carbapenemases produced by imipenem-resistant Acinetobacter baumannii and the changes in drug resistance in these strains

目的研究临床分离的耐亚胺培南鲍曼不动杆菌产碳青霉烯酶以及菌株耐药性变迁情况。方法改良的Hodge试验检测耐亚胺培南鲍曼不动杆菌产碳青霉烯酶情况;K-B纸片扩散法对临床分离的耐亚胺培南鲍曼不动杆菌菌株进行药敏分析,了解耐药性变迁情况。结果临床分离的62株耐亚胺培南鲍曼不动杆菌改良Hodge试验阳性15株,阳性率为24.19%,且耐亚胺培南鲍曼不动杆菌产碳青霉烯酶率逐年上升。临床分离菌株主要来源于痰液及分泌物,病区以ICU最多(占20.97%),其次为急诊科和神经外科。耐亚胺培南鲍曼不动杆菌对常用17种抗菌药物的耐药性逐年升高,且以头孢哌酮/舒巴坦最低,其次为多粘菌素E。结论耐亚胺培南鲍曼不动杆菌耐药性升高主要是由于产生了碳青霉烯酶;头孢哌酮/舒巴坦对碳青霉烯类耐药鲍曼不动杆菌有较好的抗菌活性,可作为此类细菌感染的治疗药物。

Objective To study the carbapenemases produced by imipenem-resistant Acinetobacter baumannii and the changes in drug resistance in these strains.Methods The carbapenemases produced by imipenem-resistant A.baumannii were detected with a modified Hodge test and the susceptibility of imipenem-resistant strains of A.baumannii was analyzed with KB disk diffusion to ascertain the potential these changes had to lead to resistance.Results Of 62 strains of imipenem-resistant A.baumannii isolated from clinics,15 were positive according to a modified Hodge test,indicating a rate of 24.19%.The rate of carbapenemase production by imipenem-resistant A.baumannii increased yearly.The clinically isolated strains were mainly from sputum and secretions primarily from patients in ICU（20.97%）,followed by patients in the Emergency Department and Neurosurgery.The drug resistance of imipenem-resistant A.baumannii to 17 types of commonly used antimicrobials increased yearly.A.baumannii was least resistant to cefoperazone/sulbactam,followed by polymyxin E.Conclusion The increased resistance of imipenem-resistant A.baumannii is mainly due to carbapenemase.Cefoperazone/sulbactam has more potent antibacterial activity against carbapenem-resistant A.baumannii and may be effective in treating such a bacterial infection.