2011至2013年仁济医院神经外科病房分离的鲍曼不动杆菌的耐药性变迁与同源性分析

Investigation on drug resistance variation and homology of Acinetobacter baumannii isolated from patients in neurosurgery department at Renji Hospital from 2011 to 2013

目的了解仁济医院神经外科病房分离的鲍曼不动杆菌的耐药性变迁和分子流行特征,分析菌株基因同源性,为临床治疗和医院感染控制提供依据。方法收集2011年7月至2013年6月仁济医院神经外科病房分离的鲍曼不动杆菌共87株,采用琼脂稀释法检测菌株对临床12种抗菌药物的最低抑菌浓度(MIC)。采用多位点序列分型(MLST)技术鉴定基因型别并进一步分析菌株流行特征。结果仁济医院神经外科病房分离的鲍曼不动杆菌对头孢菌素类、喹诺酮类、氨基糖苷类和碳青霉烯类抗菌药物普遍耐药,且耐药率有逐年上升趋势。87株鲍曼不动杆菌分为6个ST型,分别是ST-208(45株)、ST-191(15株)、ST-540(8株)、ST-195(2株)、ST-381(2株)和ST-368(1株),其中ST-208型是主要流行型别。除ST-381外,其余5种型别均属于CC92克隆群,具有基因同源性。结论仁济医院神经外科病房分离的鲍曼不动杆菌耐药率高且有逐年上升趋势,同时存在耐碳青霉烯类鲍曼不动杆菌的播散流行,需加强医院感染控制,防止耐药株传播。

Objective To investigate the drug resistance variation and molecular epidemiology of Acinetobacter baumannii isolated from patients in neurosurgery department at Renji Hospital and analyze the homology,in order to provide the reference for clinical treatment and nosocomial infection control. Methods A total of 87 clinical isolates of Acinetobacter baumannii were collected from July 2011 to June 3013 in neurosurgery department of Renji Hospital. The minimal inhibitory concentrations( MIC) of 12 antimicrobial agents against 87 Acinetobacter baumannii isolates were determined by agar dilution method. The genotype was identified by multilocus sequence typing technique,and the epidemiology characteristic was analyzed further. Results The 87 Acinetobacter baumannii isolates were commonly resistant to cephalosporin,fluoroquinolone,aminoglycoside and carbopenem,and the drug resistance rates increased year by year. A total of 6 genotypes were identified among 87 Acinetobacter baumannii isolates: ST-208( 45 isolates),ST-191( 15 isolates),ST-540( 8 isolates),ST-195( 2 isolates),ST-381( 2 isolates) and ST-368( 1 isolate). ST-208 was the main epidemiology type. The ST types had the homologous relevance belonging to CC92 except for ST-381.Conclusions The drug resistance rate of Acinetobacter baumannii to antimicrobial agents increases year by year,and there is dissemination characteristic,which should be paid more attention. Infection monitoring should be enhanced to reduce the spread of drug-resistant bacteria.