鲍曼不动杆菌耐药表型与基因型分析

Analysis on drug-resistant phenotype and genotype of Acinetobacter baumannii

目的了解杭州市第一人民医院临床分离的鲍曼不动杆菌菌株分布及其对常用抗菌药物的耐药性和耐药基因分布。方法分析2015年1月至12月杭州市第一人民医院常规细菌分离培养的鲍曼不动杆菌的分布情况以及耐药性,从中筛选出40株多重耐药菌株(MDR-AB),并采用聚合酶链式反应(PCR)检测相关耐药基因。结果共检出1 112株鲍曼不动杆菌,其中以痰液标本的分离率最高82.37%(916/1 112),其次为洁尿8.99%(100/1 112)。临床分布以ICU为主61.60%(685/1 112),其次为老年干部病房11.60%(129/1 112)以及呼吸内科9.98%(111/1 112)。鲍曼不动杆菌对21种常用抗菌药物的耐药率中以替加环素耐药率最低9.8%(109/1 112),其次为阿米卡星25.2%(280/1 112);对头孢西丁、头孢美唑、阿莫西林/克拉维酸耐药率最高分别为99.7%(1 109/1 112)、100.0%(1 112/1 112)、98.8%(1 099/1 112)。40株MDR-AB菌株耐药基因Tem、SHV、CTX-M-9、OXA-23、aac(3)-II、aac(6′)-Ⅰ、aac(6′)-II、ant(3″)-Ⅰ、ant(2″)-Ⅰ、ParC、GyrA、tetA、tetR检出率分别为65.0%、72.5%、70.0%、72.5%、2.5%、55.0%、87.5%、55.0%、40.0%、92.5%、87.5%、15.0%、12.5%。结论本院鲍曼不动杆菌耐药情况严重,耐药机制复杂。

Objective To determine the distribution of Acinetobacter baumannii strains clinically isolated in the First People′s hospital of Hangzhou as well as its drug resistance to commonly used antimicrobials and distribution of resistant genes.Methods The distribution pattern and drug resistance of Acinetobacter baumannii obtained through routine bacterial culture and isolation from January 2015 to December 2015 were analyzed;40multiple drug-resistant strains were selected and then detected with polymerase chain reaction（PCR）for relevant resistant genes.Results 1,112 strains of Acinetobacter baumannii were detected.The highest isolation rate was seen in sputum specimens（82.37%,916/1,112）,followed by urine（8.99%,100/1,112）.Clinical distribution mainly covered ICU（61.6%,685/1,112）,geriatric cadre′s ward（11.60%,129/1,112）and respiratory medicine department（9.98%,111/1,112）.The drug resistance rate of Acinetobacter baumannii to tigecycline was the lowest at 9.8%（109/1,112）,followed by amikacin（25.2%,280/1,112）,while the highest rate was to cefmetazole（100.0%）,followed by cefoxitin（99.7%）and Amoxicillin/clavulanic acid（98.8%）.The expression rates of Tem,SHV,CTX-M-9,OXA-23,aac（3）-II,aac（6′）-I,aac（6′）-II,ant（3″）-I,ant（2″）-I,ParC,GyrA,tetAand tetRin the 40 MDRAB strains were 65.0%,72.5%,70.0%,72.5%,2.5%,55.0%,87.5%,55.0%,40.0%,92.5%,87.5%,15.0% and 12.5% respectively.Conclusion The drug resistance of Acinetobacter baumannii in our hospital is in a serious condition and the resistance mechanism is complex.