我院耐碳青霉烯鲍曼不动杆菌基因型分析

Genotyping of carbapenem-resistant Acinetobacter baumannii isolated from hospitalized patients in our hospital

目的分析佳木斯大学附属第一医院临床分离的鲍曼不动杆菌(Acinetobacter baumannii,AB)携带多重耐药相关基因β-内酰胺酶的情况,为临床合理应用抗菌药物提供理论依据。方法收集2013年9月—2015年6月佳木斯大学附属第一医院临床分离鲍曼不动杆菌110株,VITEK-II、Walkway-40全自动微生物鉴定/药敏测试系统菌种鉴定及药敏检测并进行16SrRNA鉴定;多重PCR检测鲍曼不动杆菌携带β-内酰胺酶(A、B、C、D类)的耐药基因。结果 110株鲍曼不动杆菌对头孢哌酮/舒巴坦、美洛培南、亚胺培南的耐药率较低(13. 3%、38. 5%、49. 3%)。D类碳青霉烯酶耐药基因:96株OXA-51 (87. 27%),53株OXA-23 (48. 18%),29株OXA-24(26. 36%),6株OXA-58(5. 45%)。金属酶:检出IMP 1株(0. 90%)和SIM 6株(5. 45%)。另检测出ADC 84株(76. 36%)、TEM 66株(60. 00%)、GES 16株(14. 54%)、PER 8株(7. 27%)、SHV 7株(6. 36%)、VEB 5株(4. 54%)。50株碳青霉烯类耐药的鲍曼不动杆菌中,OXA-23、OXA-51、OXA-24、ADC、TEM的检出率分别为84. 00%、92. 00%、26. 00%、92. 00%、88. 00%。碳青霉烯类耐药的鲍曼不动杆菌与碳青霉烯类敏感菌株比较OXA-23、ADC、TEM产酶基因的检出率差异具有统计学意义。结论产OXA、Amp C、ESBLs可能是我院鲍曼不动杆菌耐药的主要原因。

Objective To explore the distribution of β-Lactamase gene for resistance to β-lactamase antibiotics in Acinetobacter baumannii( A. baumannii) isolated from hospitalized patients in our hospital,and provide a reasonable basis for the clinical selection of antimicrobial drugs. Methods Total 110 strains of A. baumannii collected at the First Affiliated Hospital of Jiamusi University from September 2013 to June 2015 were tested for the bacteria identification and drug susceptibility by using the VITEK-II and Walkway-40 VITEK 2 COMPACT automatic microbiology analyzer. 16 S r RNA gene sequencing and multiplex PCR for identification of Ambler class A beta-lactamases were performed. Results The resistant rate of 110 A. baumannii samples to SCF,MEM and IMP were 13. 3%,38. 5% and 49. 3%,respectively. The Ambler class D beta-lactamases gene were as follows: 96 strains of OXA-53,OXA-23 strains( 48. 18%),29 strains OXA-24( 26. 36%),6 strains of OXA-58( 5. 45%),mainly OXA-51 and OXA-23;metal enzyme B included 1 strain of IMP( 0. 90%) and 6 strains of SIM( 5. 45%),84 strains of ADC( 76. 36%),66 strains of TEM( 60. 00%),16 strains of GES( 14. 54%),8 strains of PER( 7. 27%),7 strains of SHV( 6. 36%),and 5 strains of VEB( 4. 54%).Among 50 strains of carbapenem-resistant A. baumannii,the detection rate of OXA-23,OXA-51,OXA-24,ADC and TEM were 84. 00%,92. 00%,26. 00%,92. 00% and 88. 00%,respectively. When compared with carbapenem-sensitive A. baumannii, there was significant difference in the positive of CSAB OXA-23, ADC and TEM gene.Conclusion OXA,Amp C and extended spectrum β-Lactamase may be responsible for the resistance to β-lactamase antibiotics in A. baumannii in our hospital.