426株鲍曼不动杆菌的耐药性分析与OXA-23型碳青霉烯酶检测

Analysis of the antibiotic resistance and detection of OXA-23 carbapemase in 426 Acinetobacter baumannii strains

目的了解暨南大学附属第一医院2009年至2011年鲍曼不动杆菌的分布特点和耐药状况,为临床合理使用抗生素提供依据,同时研究广州地区亚胺培南耐药鲍曼不动杆菌中OXA-23型碳青霉烯酶的分子流行病学特征。方法利用梅里埃VITEK-2 Compact微生物分析仪鉴定细菌,K-B法进行药敏试验,采用WHONET 5.6软件统计分析药敏结果,PCR检测OXA-23型碳青霉烯酶的编码基因。结果 2009年至2011年临床分离出426株鲍曼不动杆菌,主要分离自呼吸科病房(119株,占27.9%)和ICU病房(107株,占25.1%),标本类型以痰液为主(361株,占84.7%),鲍曼不动杆菌对12种抗生素的耐药率总体呈逐年上升趋势,对亚胺培南的耐药率从13.2%上升到39.3%,在124株亚胺培南耐药鲍曼不动杆菌中PCR检出98株OXA-23型碳青霉烯酶阳性菌株。结论鲍曼不动杆菌对各种抗菌药物的耐药性逐年增强,产OXA-23型碳青霉烯酶是其对亚胺培南耐药的主要机制之一。

Objective To analyze the distribution characteristics and antibiotic resistance of Acinetobacter baumannii isolated in our hospital from 2009 to 2011,guiding the reasonable use of antibiotics in clinical practice,and investigate the molecular epidemiology of OXA-23 in imipenem-resistant A.baumannii in Guangzhou.Methods The bacteria were identified with Bio-Merieue VITEK-2 Compact system and drug sensitivity was detected with K-B method.WHONET 5.6 software was used to analyze the data,and OXA-23 gene was determined by PCR amplification.Results 426 A.baumannii strains were isolated,which mainly came from the respiratory department（119 strains,27.9%） and ICU（107 strains,25.1%）.Sputum was the main source of the pathogen（361 strains,84.7%）.A.baumannii was resistant to 12 kinds of antibiotics and the rate showed an increasing trend by years,especially to imipenem,which increased from 13.5% to 49.1%.98 isolates produced OXA-23 carbapemase in 124 imipenem-resistant A.baumannii strains.Conclusion The antibiotic resistance of A.baumannii is increasing year by year,and the producing of OXA-23 is the main mechanism of A.baumannii imipenem resistance.