2012-2014年住院患者鲍曼不动杆菌耐药性变迁及耐药基因检测

Changes in the drug resistance of and detection of drug resistance genes in Acinetobacter baumannii infecting patients with a respiratory tract infection from 2012-2014

目的研究住院患者感染鲍曼不动杆菌的耐药性变迁及耐药基因检出情况,为抗感染治疗及控制耐药性发展提供指导。方法收集本院呼吸道疾病住院患者的送检样本,从中分离鲍曼不动杆菌临床株,采用K-B法进行耐药性分析,PCR扩增法进行耐药基因检测。结果2012-2014年住院患者呼吸道标本中共分离鲍曼不动杆菌377株。2012年分离的106株鲍曼不动杆菌对头孢吡肟、头孢噻肟、头孢他啶、阿米卡星、亚胺培南、左氧氟沙星、环丙沙星、庆大霉素、氨苄西林、氨曲南的耐药率分别为83.02%、85.85%、75.47%、52.83%、55.66%、64.15%、56.60%、57.55%、72.64%和100.00%;2013年127株菌的耐药率分别为76.38%、70.87%、78.74%、48.82%、62.20%、81.89%、48.82%、47.24%、74.80%和100.00%;2014年144株菌的耐药率分别为75.69%、77.08%、79.17%、43.75%、74.31%、65.28%、61.11%、43.06%、75.00%和100.00%。2012年分离菌中OXA-23基因、OXA-58基因、TEM基因、PER基因、IMP基因、CTX-M-9基因的阳性检出率分别为27.36%、4.72%、32.08%、16.04%、9.43%和3.77%;2013年各基因的阳性检出率分别为32.28%、11.81%、34.65%、18.90%、11.02%和4.72%;2014年各基因的阳性检出率分别为49.31%、16.67%、38.19%、18.75%、25.69%和8.33%。结论 2012-2014年分离的鲍曼不动杆菌对头孢类抗生素的耐药程度均明显较高,研究菌株耐药基因对控制菌株耐药性发展具有重要意义。

Objectives To study changes in the drug resistance of Acinetobacter baumannii infecting inpatients and to detect drug resistance genes in that bacterium in order to guide treatment of infections and to control the drug resistance of that bacterium. Methods Samples were collected from inpatients with a respiratory disease and sent for testing.Clinical strains of A.baumannii were isolated.Drug resistance was analyzed using the K-B method,and drug resistance genes were detected via amplification with PCR Results Three hundred and seventy-seven strains of A.baumannii were isolated from respiratory tract samples of inpatients from 2012-2014.One hundred and six strains of A.baumannii isolated in 2012 were resistant to cefepime at a rate of 83.02%,to cefotaxime at a rate of 85.85%,to ceftazidime at a rate of 75.47%,to amikacin at a rate of 52.83%,to imipenem at a rate of 55.66%,to levofloxacin at a rate of 64.15%,to ciprofloxacin at a rate of 56.60%,to gentamycin at a rate of 57.55%,to ampicillin at a rate of 72.64%,and to aztreonam at a rate of 100.00%.One hundred and twenty-seven strains of A.baumannii isolated in 2013 were resistant to cefepime at a rate of 76.38%,to cefotaxime at a rate of 70.87%,to ceftazidime at a rate of 78.74%,to amikacin at a rate of 48.82%,to imipenem at a rate of 62.20%,to levofloxacin at a rate of 81.89%,to ciprofloxacin at a rate of 48.82%,to gentamycin at a rate of 47.24%,to ampicillin at a rate of 74.80%,and to aztreonam at a rate of 100.00%.One hundred and forty-four strains of A.baumannii isolated in 2014 were resistant to cefepime at a rate of 75.69%,to cefotaxime at a rate of 77.08%,to ceftazidime at a rate of 79.17%,to amikacin at a rate of 43.75%,to imipenem at a rate of 74.31%,to levofloxacin at a rate of 65.28%,to ciprofloxacin at a rate of 61.11%,to gentamycin at a rate of 43.06%,to ampicillin at a rate of 75.00%,and to aztreonam at a rate of 100.00%.In 2012,the OXA-23 gene was detected at a rate of 27.36%,the OXA-58 gene was detected at a rate of 4.72%,the TEM gene was detected at a rate of 32.08%,the PER gene was detected at a rate of 16.04%,the IMP gene was detected at a rate of 9.43%,and the CTX-M-9 gene was detected at a rate of 3.77%.In 2013,the OXA-23 gene was detected at a rate of 32.28%,the OXA-58 gene was detected at a rate of 11.81%,the TEM gene was detected at a rate of 34.65%,the PER gene was detected at a rate of 18.90%,the IMP gene was detected at a rate of 11.02%,and the CTX-M-9 gene was detected at a rate of 4.72%.In 2014,the OXA-23 gene was detected at a rate of 49.31%,the OXA-58 gene was detected at a rate of 16.67%,the TEM gene was detected at a rate of 38.19%,the PER gene was detected at a rate of 18.75%,the IMP gene was detected at a rate of 25.69%,and the CTX-M-9 gene was detected at a rate of 8.33%. Conclusion A.baumanniiisolated from 2012-2014 was highly resistant to cephalosporin antibiotics,and studying drug resistance genes in strains is crucial to controlling their drug resistance.