鲍曼不动杆菌临床耐药情况及AmpC酶基因型分析

Clinical drug resistance and AmpC enzyme genotype analysis of Acinetobacter baumannii

目的统计本院鲍曼不动杆菌耐药情况,进一步分析AmpC酶流行分布,为临床合理用药提供直接依据。方法收集259株鲍曼不动杆菌临床菌株,细菌室做常规抗生素耐药监测;改良Hodge实验筛选出产AmpC酶菌株,PCR检测AmpC酶基因。结果本院分离的鲍曼不动杆菌主要来源于重症医学科、神经内科及神经外科等科室;对头孢曲松和头孢哌酮耐药率最高,分别为81.46%和78.38%,对阿米卡星和环丙沙星耐药率较高,分别为51.35%和41.70%;对头孢西丁耐药率为21.23%;碳青霉烯类抗生素敏感性最高,高达95%以上;Hodge实验筛选出53株产AmpC酶菌株,AmpC酶基因PCR扩增阳性者49株,其中ADC基因型占比95.92%(47株),ACT-1型占比4.08%(2株),未检出DHA、VCC和MOX基因型。结论本院鲍曼不动杆菌对常规药物耐药形势较严峻,产AmpC酶的细菌基因型主要为ADC型。

Objective To summarize the drug resistance of Acinetobacter baumannii in this hospital,and to further analyze the distribution of AmpC enzyme,so as to provide direct basis for clinical rational drug use. Methods A total of 259 strains of Acinetobacter baumannii were collected and the bacterial cells were monitored by routine antibiotic resistance. AmpC enzyme was screened by modified Hodge experiment. The AmpC enzyme gene was detected by PCR. Results The isolates of Acinetobacter baumannii were mainly from the Departments of Severe Medicine,Neurology and Neurosurgery. The antibiotic resistance rate of cephalosporins was about 80%,and the resistant rates to amikacin and ciprofloxacin was 51. 35% and 41. 70%,respectively.The resistance rate to cefoxidin was 21. 23%,the efficiency of carbapenem antibiotics was more than 95%. In the Hodge experiment,53 strains of AmpC-producing strains were screened,and 49 strains of AmpC enzyme gene were positive in PCR amplification,of which ADC gene type accounted for 95. 92%（47 strains）,ACT-1 type accounted for 4. 08%（2 strains）,and DHA,VCC and MOX genotypes were undetected. Conclusion The antibiotic resistance of Acinetobacter baumannii to the conventional drug is more severe,and the bacterial genotype of AmpC enzyme is mainly ADC type.