耐亚胺培南鲍氏不动杆菌的耐药性与同源性分析

Study on antibiotic resistance and genetic homology of imipenem-resistant Acinetobacter baumannii

目的分析医院临床分离的41株耐亚胺培南鲍氏不动杆菌(IRAB)的耐药性与同源性,指导临床合理用药,有效预防医院感染。方法收集医院2009年11月-2011年5月41株IRAB,采用K-B法检测耐药性,ERIC-PCR及琼脂糖凝胶电泳进行基因分型,引物序列为ERIC2(5′-AAGTAAGTGACTGGGGTGAGCG-3′)。结果 41株IRAB对米诺环素耐药率最低,为14.6%,其次为头孢哌酮/舒巴坦,为39.0%,对其他的抗菌药物耐药率为70.7%～100.0%;41株鲍氏不动杆菌经ERIC-PCR基因分型,分为A、B、C、D、E、F 6型,其中A型29株,B型8株,C、D、E、F型各1株;A型分布在外科ICU、呼吸内科ICU、神经外科、急诊科,B型分布在外科ICU、呼吸内科ICU与胃肠外科。结论 IRAB耐药现象严重,对米诺环素和头孢哌酮/舒巴坦耐药率较低,存在克隆株在病房内以及病房间播散现象。

OBJECTIVE To study the antibiotic resistance and genetic homology of 41 strains of imipenem-resistant Acinetobacter baumannii isolated from the hospital so as to guide the reasonable clinical use of antibiotics and effectively prevent nosocomial infections.METHODS A total of 41 strains of imipenem-resistant A.baumannii isolated from Nov 2009 to May 2011 were collected,then the drug susceptibility testing was performed with KirbyBauer（K-B）method.The homology of these isolates was analyzed by ERIC-PCR and agarose gel electrophoresis,and the primers used was ERIC2（5′-AAGTAAGTGACTGGGGTGAGCG-3′）.RESULTS The drug resistance rate of the 41 strains of imipenem-resistant A.baumannii to minocycline was the lowest（14.6%）,followed by cefoperazone-sulbactam（39.0%）;the drug resistance rate to other antibiotics varied from 70.7% to 100.0%.Totally 41strains of imipenem-resistant A.baumannii were identified as 6clones by ERIC-PCR,including A type（29strains）,B type（8strains）,C type（1strain）,D type（1strain）,E type（1strain）,F type（1strain）.Type A distributed in surgical ICU,respiratory medicine ICU,neurosurgery department,and emergency department;type B distributed in the surgical ICU,respiratory medicine ICU,and gastrointestinal surgery department.CONCLUSION The imipenem-resistant A.baumannii strains pose a serious situation of multidrugresistance,and the drug resistance rate to minocycline or cefoperazone-sulbactam is relatively low.The outbreak of nosocomial infections is due to the tranmission of the clone strains in the ward or between the wards.