呼吸重症监护病房多重耐药鲍曼不动杆菌耐药基因检测及耐药性分析

Detection and analysis of drug-resistant genes of multi-drug resistant Acinetobacter baumannii in respiratory intensive care unit

目的了解呼吸重症监护病房内多重耐药鲍曼不动杆菌(MDR-AB)β-内酰胺酶基因和耐消毒剂磺胺复合物基因(qacE△1-sull)的耐药性,为临床的合理用药提供依据。方法对分离出的39株MDR-AB采用聚合酶链反应(PCR)及序列分析方法检测耐药基因,并且进行耐药性分析。结果 39株MDR-AB中28株碳青霉烯酶-23(OXA-23)阳性(71.8%),OXA-51阳性39株(100%),青霉素酶(TEM)阳性7株(17.9%),二十二碳六烯酸(DHA)阳性6株(15.4%),丝氨酸酶(PER)阳性5株(12.8%),头孢菌素酶(AmpC)阳性23株(59.0%),qacE△1-sull阳性39株(100%)。OXA-23和AmpC同时阳性17株(43.6%)。OXA-24,OXA-58,内膜蛋白酶-1(IMP-1),IMP-4,波形蛋白酶(VIM-2)和产巯基变量型(SHV)均未检出。在呼吸重症监护病房分离出来的菌株对哌拉西林、头孢他啶、环丙沙星、氨苄西林、头孢哌酮、头孢克洛、头孢唑啉的耐药率均>90%,对多黏菌素B的敏感率为100%。结论本院呼吸重症监护病房内MDR-AB主要携带的β-内酰胺酶基因为OXA-23和AmpC,根据其院内感染特征,为控制其传播,临床应加强有效的监测和隔离工作。

Objective To investigate the antimicrohial resistance of β-lactamase gene and disinfectants- sulfanilamide-resistance（qacE△1-sull） gene in multi-drug resistant Acinetobacter baumannii（MDR-AB） in respiratory intensive care unit. To provide evidence for rational antibiotics administration. Methods Thirty-nine strains of MDR- AB were separated. The related genes were analyzed by polymerase chain reaction （PCR） and verified by DNA sequencing. Results In thirty-nine strains of MDR-AB, the positive rates of carbapenemase （OXA-23）, OXA-51, penicillinase（TEM）, docosahexaenoic acid （DHA）, serinase （PER）, cephalosporinase （AmpC） and qaeEAl-sull were 71.8%, 100%, 17.9%, 15.4%, 12.8%, 59.0%, 100%. Both OXA-23 and AmpC were identified in 43.6% （17/39） strains. While IMP-l, IMP-4, OXA-24, OXA-58, sulphydryl variable（SHV） and vimentin（VIM-2） were not identified. In the respiratory intensive care unit, the resistant rates of the separated strains to piperacillin, ceftazidime, ciprofloxacin,ampicillin, efoperazone, cefaclor and cefazolin were more than 90%, and the sensitivity rates of the separated strains to polymyxin B were 100%. Conclusion OXA-23 and AmpC are the major β-lactamase genes carried on MDR-AB in the respiratory intensive care unit. According to the clinical infection characteristics,effective monitoring and quarantine work should be strengthened for controlling the epidemic of these strains.