醋酸钙-鲍曼不动杆菌复合体临床分离株多重PCR分型和感染特征分析

The characteristics of infection and genotyping of A.calcoaceticus-A.baumannii complex by multiplex PCR

目的在临床微生物实验室建立醋酸钙-鲍曼不动杆菌复合体分型的方法,对相应菌株的药敏情况和临床特征进行分析,为临床准确诊断和有效治疗提供参考依据。方法收集苏州大学附属第一医院2015年10月至2016年1月临床分离的45株醋酸钙-鲍曼不动杆菌复合体菌株,用多重PCR法进行基因分型,用K-B法进行药敏试验,并采用SPSS 17.0软件进行统计分析。结果 45株醋酸钙-鲍曼不动杆菌复合体用多重PCR法鉴定为鲍曼不动杆菌38株,基因3型5株,基因13TU 2株,未鉴定出醋酸钙不动杆菌。标本来源以痰最多(35例),其次为血液标本(6例),脑脊液(2例)。科室分布在神经外科(11例)和ICU(10例)最多,其次是重症医学科(7例)和心胸大外科(6例)。年龄分布以41~60岁(17例)以及61~80岁(15例)两个年龄段最多;性别分布以男性较多(31例),女性较少(14例),而且各个年龄段男性均多于女性。在8种临床常用药物中,对头孢吡肟、哌拉西林、哌拉西林/他唑巴坦、环丙沙星和亚胺培南的耐药率均超过了70.0%,其中哌拉西林的耐药率最高(84.4%),阿米卡星的敏感率最高(51.1%)。结论多重PCR技术能对醋酸钙-鲍曼不动杆菌复合体进行快速基因分型,它成本低、操作简便,适合在临床微生物实验室推广。目前鲍曼不动杆菌引起的感染形势严峻,患者以中老年患者、男性、呼吸道感染、神经外科和ICU科室居多。鲍曼不动杆菌感染大多呈多重耐药甚至泛耐药。推荐临床通过积极治疗原发病,医护人员做好手卫生,加强消毒隔离,根据药敏结果合理选择抗生素等方法尽量减少和延缓耐药菌株的出现。

Objective To establish a method for genotyping of A. calcoaceticus-A, baumannii complex （Acb complex） in clinical microbiology laboratory, analyze the drug sensitivity and clinical characteristics of the strains. And provide reference for clinical accurate diagnosis and effective treatment. Methods 45 strains of Acb complex isolated from October 2015 to January 2016 in our hospital were genotyped with multiplex PCR. Drug sensitivity test was carried out with K-B method, and the results were analyzed with SPSS 17.0 software. Results The 45 strains of Acb complex were identified as 38 strains of Acinetobacter baurnannii, 5 strains of Acinetobacter genomospecies 3 and 2 strains of Acinetobacter genomospecies 13TU; Acinetobact- er calcoaceticus was not detected. Most of the strains were isolated from sputum （35 cases）, blood （6 cases） and cerebrospinal fluid （2 cases）, which mainly distributed in the departments of neurosurgery （11 cases）, ICU （10 cases）, CCM （7cases） and cardio-thoracic surgery （6 cases） . Patients at the ages of 41 - 60 years （17 cases） and 61 - 80 years （15 cases） occupied the most; male patients （31 cases） were more than female ones （14 cases） . The resistance rates of the pathogen to Cefepime, Piperacillin, Piperacillin/Tazobactam, Ciprofloxacin and Imipenem were higher than 70.0%; the resistance rate to Piperacillin was the highest （84.4 %）, and the highest sensitivity rate was to Amikacin （51.1 %） . Conclusion Multiplex PCR can be used for quick genotyping of Acb complex, which is low-cost, easy to operate, and suitable for clinical mi-crobiology laboratory. Acinetobacter baumannii infection has become a major cause of concern which usually affects elderly or male patients or those in respiratory, neurosurgery or ICU departments. The pathogen shows multi-drug resistance and even pan-drug resistance. Clinicians should take effective measures and use antibacterial drugs rationally according to the results of drug sensitivity test.