实时荧光定量PCR法对ICU患者痰液标本中鲍曼不动杆菌耐药基因的检测及其评价

Detection of drug resistance genes of Acinetobacter baumannii in sputum samples of ICU patients by real-time fluorescence quantitative PCR method and its evaluation

目的:探讨重症监护病房(ICU)患者感染鲍曼不动杆菌(AB)的碳青霉烯类药物耐药情况,阐明实时荧光定量PCR (RT-qPCR)法进行耐药基因检测的临床应用价值。方法:收集ICU患者的痰液标本285份,分别进行传统培养鉴定药敏和RT-qPCR耐药基因检测。统计分析耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率、耐药基因检测的符合率和其他抗菌药物的耐药情况。结果:共检出AB 151株,检出率为52.98%。AB对碳青霉烯类药物耐药率为72.20%。采用RT-qPCR法检测OXA-51基因检出AB的符合率与传统培养方法比较差异无统计学意义(P>0.05)。OXA-23基因检出CRAB的符合率与传统培养方法比较差异无统计学意义(P>0.05)。108株AB感染OXA-23阳性标本对米诺环素、头孢哌酮/舒巴坦、黏菌素和替加环素的耐药率较低。结论:ICU患者痰液标本培养鉴定出AB的耐碳青霉烯类药物的检出率高。与传统培养方法比较,RT-qPCR法更简便、快速,且检测符合率更高。CRAB对米诺环素、头孢哌酮/舒巴坦、黏菌素和替加环素的耐药率低。

Objective:To investigate the carbapenem drug resistance of the intensive care unit(ICU)patients infected with Acinetobacter baumannii(AB),and to clarify the clinical application value of realtime fluorescence quantitative PCR(RT-qPCR) method for the detection of drug resistance genes.Methods:A total of 285 sputum specimens from the ICU patients were collected for identification of the drug susceptibility by traditional culture method and detection of the drug resistance genes by RT-qPCR method. Statistical analysis was performed on the detection rate of the carbapenem-resistant Acinetobacter baumannii(CRAB),the coincidence rate of the drug resistance gene detection and the drug resistance of other antibiotics. Results:A total of 151 strains of AB were obtained,the detection rate was 52. 98%.The drug resistance rate of AB to carbapenem was 72. 20%. There was no significant difference in the coincidence rate of OXA-51 gene detected by RT-qPCR method compared with the traditional culture method(P>0. 05). There was no significant difference in the coincidence rate of CRAB detected by OXA-23 gene compared with the traditional culture method(P>0. 05). The drug resistance rates of108 OXA-23 positive specimens infected with AB to minocycline,cefoperazone/sulbactam,myxin,and tegacyclin were lower. Conclusion:The detection rate of carbapenem resistant drugs of AB identified by sputum culture of the ICU patients is high. Compared with traditional culture method,RT-qPCR method is simpler,faster and has a higher consistent rate of detection. The drug resistance rates of CRAB to minocycline,cefoperazone/sulbactam,myxin and tegacyclin are low.