耐亚胺培南鲍曼不动杆菌产碳青霉烯酶基因型研究

The genotype of Acinetobacter baumannii producing carbapenem enzyme-resistance to imipenem

目的了解安徽省铜陵市人民医院耐亚胺培南鲍曼不动杆菌耐药特性及产碳青霉烯酶基因型。方法用纸片扩散法检测该院2008年1～12月临床分离的31株耐亚胺培南鲍曼不动杆菌对19种常用抗菌药物的敏感性。结果用WHONET5.3软件进行数据统计;应用聚合酶链反应(PCR)检测IMP、VIM-1、VIM-2、SIM-1、OXA-23、OXA-24、OXA-51、OXA-58等碳青霉烯酶基因型。结果 31株耐亚胺培南鲍曼不动杆菌有23株分离自重症监护病房;对19种临床常用抗菌药物除米诺环素耐药率为9.7%、头孢哌酮/舒巴坦为51.6%外,其余都在90.0%以上;碳青霉烯酶基因型检测除1株单产OXA-23型外,其余30株均同时产OXA-23型和OXA-66型碳青霉烯酶。结论该院耐亚胺培南鲍曼不动杆菌在重症监护病房有小范围暴发流行的可能;耐亚胺培南鲍曼不动杆菌对临床常用抗菌药物耐药率极高;同时产OXA-23、OXA-66型碳青霉烯酶可能是其对碳青霉烯类抗菌药物耐药的主要原因。

Objective To investigate the characteristics of Acinetobacter baumannii resistance to imipenem and the genotypes of Acinetobacter baumannii producing carbapenem enzyme. Methods Tested the sensitivity of 31 Acinetobacter baumannii resist ance to imipenem isolated from our hospital all year 2008 against 19 kinds of antibiotics by disk diffusion method（KB） ,the sensitivity results were analyzed usingWHONET 5. 3; the gcnotypes of the carbapenem enzyme, including IMP, VIM-1, VIM-2, SIM-1, OXA 23,OXA 24,OXA-51,0XA-58 were detected by PCR. Results Among 31 strains, 23 Acinetobacter baumannii resistant to imipenem were from ICU wards, the resistance rate of minocycline was 9.7%, cefoperazone / sutbactam was 51.6 %, the resistance rates of other antibiotics were more than 90 % ;The genotype detection of the carbapenem enzyme-producing genes showed that only 1 produced OXA 23 , the remaining 30 strains produced both OXA 23 and OXA-66 carbapenem enzyme-producing genes. Conclusion A small prevalence caused by imipenem-resistant Acinetobacter baumannii perhaps emerged in the ICU ward; For clinical antimicrobial drug used commonly, the drug resistance rates of Acinetobacter baumannii were very high; additionally,carbapenem enzyme-producing may be the main factor which caused the carbapenem antibiotic resistance.