院内多重耐药鲍曼不动杆菌分子流行病学和耐药性研究

The Research of Molecular epidemiology and drug resistance of multidrug-resistant Acinetobacter baumannii in hospital

目的分析院内临床和环境多重耐药鲍曼不动杆菌(MDRAB)的耐药机制和分子流行病学特征,为预防和控制MDRAB的传播提供依据。方法收集2020年5月至2021年4月院内临床及环境分离到的非重复MDRAB菌株34株,其中临床标本25株,环境标本9株。应用PCR和测序方法检测MDRAB的耐药基因。多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)对MDRAB进行分子分型。结果34株MDRAB阳性基因携带率分别为:blaOXA23、blaOXA-51及blaOXA64gp均为100%,TEM 85.3%(29/34)。25株临床MDRAB监测到7个ST序列类型:分别为ST540(10/25)、ST195(5/25)、ST369(3/25)、ST208(2/25)、ST381(2/25)、ST938(2/25)和ST451(1/25);6个克隆群:分别为A群(9/25)、D群(8/25)、C群(4/25)、F群(2/25)、E群(1/25)、G群(1/25)。9株环境MDRAB监测到2个ST序列类型:ST208(8/9)、ST540(1/9);2个克隆群:B群(8/9)、C群(1/9)。结论院内MDRAB主要来源于重症监护病房,blaOXA-51-Like+blaOXA-23+blaTEM-like是主要碳青霉烯耐药模式。院内临床流行的主要序列类型为ST540和ST195,主要的克隆群为A群、D群。ST540、A克隆群MDRAB贯穿整个研究阶段且在多个重症监护病区播散流行。临床与环境MDRAB主要流行的ST序列型和克隆群存在差异。

Objective Analyze the drug-resistance mechanism and molecular epidemiological characteristics of clinical and environmental multidrug-resistant Acinetobacter baumannii(MDRAB)in hospitals,providing evidence for the prevention and control of the spread of MDRAB.Methods Collected 34non-repetitive MDRAB strains which isolated from the clinic or environment in hospital from May 2020to April 2021,including 25clinical specimens and 9environmental specimens.Detecting the resistance genes of MDRAB by PCR and gene Sequencing.And Multilocus sequence typing(MLST)and Pulsed field gel electrophoresis(PFGE)were used for typing the molecular type of MDRAB.Results The positive gene carrying rates of the 34MDRAB are:blaOXA23,blaOXA-51and blaOXA64gpare all 100%,TEM 85.3%(29/34)。7ST sequence types were monitored in 25clinical MDRAB strains,inclouding ST540(10/25),ST195(5/25),ST369(3/25),ST208(2/25),ST381(2/25),ST938(2/25),ST451(1/25),6clone groups:Group A(9/25),Group D(8/25),Group C(4/25),Group F(2/25),Group E(1/25),Group G(1/25).2ST sequence types were detected in 9strains of environmental MDRAB:ST208(8/9)and ST540(1/9),2clone groups:Group B(8/9),Group C(1/9).Conclusion MDRAB in the hospital mainly comes from the intensive care unit,the main Carbapenem resistance mode are blaOXA-51-Like+blaOXA-23+blaTEM-like.The main popular sequence types in hospital are ST540and ST195,and the main clone groups are group A and group D.ST540and clone Group A runs through the entire research phase and spreads in multiple intensive care units.The main ST sequence types and clonal Groups are different between clinical and environmental MDRAB.