呼吸病区碳青霉烯耐药鲍曼不动杆菌的分子流行病学分析

Molecular Epidemiology and Resistant Mechanisms of Carbapenem-Resistant Acinetobacter baumannii in Respiratory Area

目的研究呼吸病区碳青霉烯耐药鲍曼不动杆菌耐药机制及分子流行病学,为控制碳青霉烯耐药鲍曼不动杆菌的院内传播提供依据。方法呼吸病区19株非同一患者、1株医护人员手和3株病房围帘,共23株碳青霉烯耐药鲍曼不动杆菌用Phoenix100微生物鉴定系统进行菌种鉴定和药敏,用随机引物多态性DNA(RAPD)分型,脉冲场凝胶电泳(PFGE)进行同源性分析,PCR方法检测IMP、OXA、VIM、TEM耐药基因型以及Ⅰ、Ⅱ类整合子。结果23株碳青霉烯耐药鲍曼不动杆菌对亚胺培南(IPM)和美罗培南(MEM)耐药,对黏菌素敏感率为100%中除1株病人来源株以外,其余22株对10种抗菌药物均具有相同药敏谱,脉冲场凝胶电也显示该22株为同一组。碳青霉烯类耐药鲍曼不动杆菌携带TEMβ内酰胺酶、OXA-23苯唑西林酶、Ⅰ类整合酶阳性率分别为95.7%、69.5%及82.6%。结论碳青霉烯类耐药鲍曼不动杆菌耐药机制复杂,呼吸病区医院感染爆发可能与医护人员手卫生和病房围帘相关,应采取有效的院内感染预防与控制措施。

Objective To study the molecular epidemiology and drug resistant mechanism of carbapenem-resistant Acinetobacter baumanii in respiratory area to provide the evidence for control of nosocomial infection.Methods A total of 23 carbapenem-resistant Acinetobacter baumannii strains including 19 non-identical patients,1 medical worker hands,and 3 ward curtains in respiratory area.The Phoenix-100 microbiological identification system was adopted perform the identification and drug sensitive test.Using random primer polymorphism DNA(RAPD)for typing,pulsed field gel electrophoresis(PFGE)for homology analysis,PCR detection of IMP,OXA,VIM,TEM for drug resistance genotypes,and class Ⅰ and Ⅱ integrons.Results Among the 23 strains of carbapenem-resistant Acinetobacter baumannii except one patient-derived strain,the remaining 22 strains had the same drug-sensitivity spectrum for 10 antibacterial agents,and were resistant to IPM and MEM.Pulsed field gel electrophoresis was also shown the 22 strains were the same group.Conclusion Carbapenem-resistant baumannii infection in respiratory area may be associated with hand hygiene of medical workers and ward curtains,effective prevention and control measures for nosocomial infections should be taken.