摘要
目的调查医院重症监护病房(ICU)分离鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制,为ICU鲍氏不动杆菌感染治疗的抗菌药物选择提供理论依据。方法收集2010年1月-2014年1月ICU住院患者分离到的135株非重复鲍氏不动杆菌,采用VITEK-2Compact全自动微生物分析系统进行鉴定及药敏分析,采用PCR法检测blaVIM、blaNDM、blaOXA-23/24、blaIMP、blaKPC及blaOXA-51/58等碳青霉烯酶耐药基因,采用PCR检测ISAba1基因并与碳青霉烯酶基因连锁检测。结果 4年ICU分离出鲍氏不动杆菌135株,年龄>60岁患者分离的鲍氏不动杆菌最多52株,占38.52%;ICU患者痰液标本中检出鲍氏不动杆菌最多79株占58.52%,其次为分泌物及尿液,分别占20.00%及11.11%;鲍氏不动杆菌对氨苄西林耐药率最高为94.81%,对美罗培南和亚胺培南的耐药率分别为32.95%和34.07%;对选取的46株碳青霉烯类耐药菌进行基因检测显示,46株均携带有blaOXA-51-like基因,46株菌携带ISAba1基因;40株携带blaOXA-23-like基因,对blaOXA-23-like基因测序,进行比对后确定为blaOXA-23基因,并同时检出ISAba1-blaOXA-23连锁基因;未检出blaKPC、blaIMP、blaVIM、blaOXA-58-like、blaOXA-24-like及blaNDM基因。结论 ICU患者分离的鲍氏不动杆菌耐药性严重,以老年患者居多,主要分离自痰液标本,其中碳青霉烯耐药株常携带有OXA-23型碳青霉烯酶基因,并与ISAba1连锁携带。
OBJECTIVE To investigate the carbapenem-resistance mechanism of Acinetobacter baumannii isolated from the intensive care unit（ICU）,and to provide a theoretical basis for the antibiotics selection to treat A.baumannii infection in ICU.METHODS Totally 135 clinical isolates of non-repetitive A.baumannii isolated from ICU in our hospital from Jan.2010 to Jan.2014 were collected.A.baumannii were isolated and identified routinely by VITEK-2compact.PCR was used to detect the carbapenemase-resistant genes including blaVIM,blaNDM,blaOXA-23/24,blaIMP,blaKPC and blaOXA-51/58. Meanwhile,PCR was used to detect the ISAba1-blaOXA-23 genes.RESULTS One hundred and thirty-five A.baumannii strains were isolated from diverse specimens in the ICU of our hospital in four years.The most strains（52strains,38.52%）were found in patients over60 years old.In addition,most of the strains were isolated from sputum species,accounting for 58.52%（79strains）,followed by secretions（20.00%）and urine（11.11%）.A.baumannii strains showed the highest resistance rate of 94.81%to ampicillin and a resistance rate of 32.95%to meropenem and 34.07%to imipenem.Carbapenemase gene detection showed among the 46 selected carbapenem-resistant A.baumannii strains,100.00% of the strains carried blaOXA-51-1ike gene,100.00%（46/46）carried ISAba1 gene,and 86.95%（40/46）carried blaOXA-23 gene.Gene sequencing of blaOXA-23-like confirmed them to be blaOXA-23 genes after comparison.Meanwhile,the ISAba1 gene was detected.Other genes including blaKPC,blaIMP,blaVIM,blaOXA-58-like,b1aOXA-24-like and blaNDM were not detected.CONCLUSION A.baumannii strains isolated from ICU in our hospital increased rapidly and exhibited high antibiotic resistant rate.Most of the patients were elderly and most of the strains were isolated from sputum.Most carbapenem-resistant strains carried blaOXA-23 type carbapenemase gene and were co-transferred by ISAba1-blaOXA-23 genes.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第3期502-505,共4页
Chinese Journal of Nosocomiology
基金
浙江省卫生厅医药卫生研究基金资助项目(2013KYA103)
