多重耐药鲍氏不动杆菌耐药性及部分耐药基因检测

Drug resistance and resistant genes in multidrug-resistant Acinetobacter baumannii

目的研究多重耐药鲍氏不动杆菌(MDR-AB)流行病学特征、耐药性及部分耐药基因阳性率。方法留取2016年7月-2017年2月于医院住院患者送检标本中分离的64株MDR-AB,统计流行病学特征,检测对15种抗菌药物的敏感性,并采用PCR技术检测TEM、ADC、OXA-23、OXA-51、ISAba1、armA、ant(3″)-Ⅰ、aac(3)-Ⅰ、aac(6′)-Ⅰ、sul1、sul2耐药基因的携带情况。结果 64株MDR-AB中,科室分布以急诊ICU为主,15株占23.44%,其次为ICU、脑中心ICU;标本来源以痰标本为主,48株占75.00%,其次为分泌物;对哌拉西林、头孢吡肟、头孢他啶、头孢曲松、哌拉西林/他唑巴坦、美罗培南、亚胺培南全部耐药,对复方新诺明的耐药性最低;以上耐药基因均有检出,β-内酰胺酶耐药基因阳性率均>80%,其中OXA-51、ISAba1基因的检出率为100.00%,氨基糖苷类修饰酶耐药基因中ant(3″)-Ⅰ的阳性率>70%,aac(3)-Ⅰ、aac(6′)-Ⅰ阳性率则较低。结论医院MDRAB耐药性强,耐药与所检测11种耐药基因有关,应进一步促进抗菌药物的合理应用。

OBJECTIVE To investigate the epidemiological characteristics,drug resistance and positive rate of resistant genes of multidrug-resistant Acinetobacter baumannii（MDR-AB）.METHODS The clinical isolates of 64 strains of MDR-AB from hospitalized patients from Jul.2016 to Feb.2017 were collected.Epidemiological characteristics were statistically analyzed,the sensitivities to 15 kinds of antibiotics were detected,and PCR was used to detect the expressions of TEM,ADC,OXA-23,OXA-51,ISAba1,armA,ant（3″）-Ⅰ,aac（3）-Ⅰ,aac（6′）-Ⅰ,sul1 and sul2.RESULTS Among the 64 strains of MDR-AB,the departments were mainly distributed in emergency ICU,which were 15 strains accounting for 23.44%,followed by ICU and brain center ICU.The samples were mainly sputum specimens,which were 48 strains accounting for 75.00%,followed by secretions.They were all resistant to piperacillin,cefepime,ceftazidime,ceftriaxone,piperacillin/tazobactam,meropenem and imipenem,and the drug resistance to compound sulfamethoxazole was the lowest.All the resistant genes were detected.The positive rate ofβ-lactamase resistance gene was80%,and the detection rates of OXA-51 and ISAba1 genes were 100.00%.The positive rate of ant（3″）-Ⅰin the aminoglycoside modifying enzyme resistance gene70%,and the positive rates of aac（3）-Ⅰ and aac（6′）-Ⅰ were lower.CONCLUSION The drug resistance of MDR-AB in our hospital is strong.Drug resistance is related to the detected 11 kinds of resistant genes,and further rational use of antibiotics should be promoted.