脑梗死患者感染多重耐药鲍曼不动杆菌耐药情况分析

Analysis of multidrug-resistant Acinetobacter baumannii infection in patients with cerebral infarction

目的研究脑梗死感染多重耐药鲍曼不动杆菌耐药特征及耐药机制。方法收集患者标本并进行鉴定。鲍曼不动杆菌耐药情况检测采用倍比稀释法。采用聚合酶链反应分析鲍曼不动杆菌耐药基因。采用荧光定量PCR检测两组患者血浆中TLR9 mRNA、miRNA-122和miRNA-146a中的相对表达量并采用SPSS进行对比。结果多重耐药鲍曼不动杆菌对哌拉西林、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、亚胺培南、美罗培南、庆大霉素、妥布霉素、阿米卡星、多粘菌素B、多西环素、四环素、环丙沙星和左氧氟沙星耐药率依次为:95.65%、82.61%、73.91%、86.96%、91.30%、69.57%、65.22%、91.30%、86.96%、65.22%、0.00%、56.52%、91.30%、78.26%和69.57%。TEM、IMP、Amp-C、OXA-23、OXA-51、OXA-58型基因携带率69.57%、21.74%、39.13%、47.83%、78.26%和8.70%,未检出SHV、VIM和OXA-24型基因。检出较多的基因组合分别是TEM+Amp-C+OXA-23+OXA-51和TEM+IMP+OXA-51,携带率分别为26.09%和21.74%。感染组TLR9 mRNA和miRNA-122相对表达量分别为7.58±1.53和2.43±0.44,均高于对照组4.52±1.42和1.58±0.32,差异均有统计学意义(P<0.05)。感染组miRNA-146a相对表达量1.46±0.30,低于对照组2.29±0.34,差异均有统计学意义(P<0.05)。结论本次研究中多重耐药鲍曼不动杆菌仅未对多粘菌素B产生耐药性。携带TEM和OXA-51型耐药基因较多,以TEM+Amp-C+OXA-23+OXA-51和TEM+IMP+OXA-51为主。TLR9 mRNA、miRNA-122和miRNA-146a对脑梗死患者院内感染有预测价值。

Objective The clinical characteristics and resistance mechanisms of multidrug-resistant Acinetobacter baumannii in patients with cerebral infarction infection were studied.Methods The patient specimens were collected and identified.The detection of antibiotic resistance of Acinetobacter baumannii was carried out using a multiple dilution method.The resistance genes of A.baumannii was analyzed Polymerase Chain Reaction.The relative expression levels of TLR9 mRNA,miRNA-122,and miRNA-146a in the plasma of two groups of patients were detected and analysed by Fluorescence quantitative PCR and analyzed by SPSS.Results The resistance rates of multidrug resistant A.baumannii to piperacillin,ampicillin/sulbactam,piperacillin/tazobactam,ceftazidime,ceftriaxone,imipenem,meropenem,gentamicin,tobramycin,amikacin,polymyxin B,doxycycline,tetracycline,ciprofloxacin and levofloxacin were 95.65%,82.61%,73.91%,86.96%,91.30%,69.57%,65.22%,91.30%,86.96%,65.22%,0.00%56.52%,91.30%,78.26%,and 69.57%.The carrying rates of TEM,IMP,Amp-C,OXA-23,OXA-51,and OXA-58 genes were 69.57%,21.74%,39.13%,47.83%,78.26%,and 8.70%,respectively.SHV,VIM,and OXA-24 genes were not detected.The most detected gene combinations were TEM+Amp-C+OXA-23+OXA-51 and TEM+IMP+OXA-51,with carrier rates of 26.09%and 21.74%,respectively.The relative expression levels of TLR9 mRNA and miRNA-122 in the infection group were 7.58±1.53 and 2.43±0.44,respectively,higher than those in the control group 4.52±1.42 and 1.58±0.32,with statistical significance(P>0.05).The relative expression level of miRNA-146a in the infection group was 1.46±0.30,lower than that in the control group by 2.29±0.34,and the data differences were statistically significant(P>0.05).Conclusion In this study,multidrug-resistant A.baumannii only did not develop resistance to polymyxin B.There were many types of resistance genes carrying TEM and OXA-51,mainly TEM+Amp-C+OXA-23+OXA-51 and TEM+IMP+OXA-51.TLR9 mRNA,miRNA-122,and miRNA-146a have predictive value for nosocomial infection in patients with cerebral infarction.