摘要
目的 调查深圳市人民医院近8年耐碳青霉烯鲍曼不动杆菌（CRAB）感染临床特征、耐药机制及其克隆变迁.方法 收集2002至2009年深圳市人民医院院内感染患者分离鲍曼不动杆菌;琼脂稀释法检测亚胺培南等抗菌药对鲍曼不动杆菌最低抑菌浓度（MICs）;聚合酶链反应（PCR）和DNA测序分析CRAB碳青霉烯酶基因型;脉冲场凝胶电泳（PFGE）分析菌株同源性;依据中国鲍曼不动杆菌感染诊治与防控专家共识,回顾性调查CRAB感染患者病历资料.结果 2002至2009年共收集到87例CRAB院内感染患者,以呼吸道感染最常见,占69.0％（60/87）,其次为血流感染占8.0％（7/87）、伤口感染占8.0％ （7/87）和腹腔感染占6.9％ （6/87）.80.5％ （70/87） CRAB来源于重症监护病房（ICu）.2009年CRAB感染迅速增多,占48.3％（42/87）,以呼吸道感染为主（34/42）.87株CRAB共获8种PFGE型别.2002至2006年,CRAB感染主要流行携带blaOXA-58-like基因的CRAB克隆A;2007至2008年主要流行CRAB克隆A和携带blaOXA-23-like基因的CRAB克隆C;2009年携带blaOXA-23-like基因对碳青霉烯高度耐药的CRAB克隆D取代克隆A和C,成为深圳市人民医院CRAB病原菌的主要克隆.结论 携带blaOXA-23-1ike基因的CRAB高耐药克隆D造成深圳市人民医院2009年CRAB感染迅速流行.
Objective To investigate the clinical features,mechanism of resistance and molecular epidemiology of carbapenem-resistant Acinetobacter baumannii （CRAB） infections at Shenzhen People＇s Hospital during an 8-year period.Methods A.baumannii isolates were recovered from nosocomial infections patients at this hospital from 2002 to 2009.The minimum inhibitory concentrations （MICs） of antimicrobial agents against A.baumannii isolates were detected by agar dilution method.Polymerase chain reaction （PCR） and DNA sequencing were used to examine the carbapenemase genotype among CRAB.All isolates were typed by pulse field gel electrophoresis （PFGE）.Clinical cases of CRAB infections were retrospectively analyzed according to Chinese experts＇ consensus on diagnosis,treatments,preventions and controls of Acinetobacter baumannii infections in China.Results A total of 87 cases of CRAB nosocomial infections were diagnosed in this study.The most prominent infections caused by CRAB was lung infections,followed by bloodstream infections,wound infections and abdominal infections,accounting for 69.0%,8.0%,8.0% and 6.9% of 87 cases,respectively.Approximately 80.5% （70/87） of CRAB isolated from intensive care unit （ICU）.A sharp increase of CRAB infections （42/87） occurred in 2009,with the majority of pulmonary infections （34/42）.Genotyping by PFGE found eight distinct PFGE patterns among 87 isolates of CRAB.The prominent CRAB clone A,carrying a blaOXA-58-like carbapenemase gene,had been prevalent from 2002 to 2006 at this hospital.The CRAB clone C,harboring a blaOXA-23-1ike carbapenemase gene,as well as clone A became the prominent clones during 2007 to 2008.The CRAB clone D,carrying a blaOXA-23-like carbapenemase gene,replaced clone A and C,and became the dominant clone in 2009.Conclusion The spread of the CRAB clone D harboring a blaOXA-23-like gene causes a rapid increase of CRAB infections at this hospital during 2009.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第8期585-590,共6页
National Medical Journal of China
基金
广东省自然科学基金（5009113）
关键词
鲍曼不动杆菌
感染
耐药
碳青霉烯酶
脉冲场凝胶电泳
Acinetobacter baumannii
Infections
Resistance
Carbapenemases
Pulsed field gel electrophoresis
