临床分离的鲍曼不动杆菌耐消毒剂基因研究及同源性分析

发布时间：2018-01-03 12:20

本文关键词：临床分离的鲍曼不动杆菌耐消毒剂基因研究及同源性分析　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析2013年10月至2014年8月四川医科大学第一院附属医院和四川省自贡市第一人民医院临床分离的133株鲍曼不动杆菌临床分布情况、碳青霉烯酶产生情况以及对18种抗菌药物的耐药谱特征,为临床合理使用抗生素提供科学依据;检测鲍曼不动杆菌的耐消毒剂基因qacE?1的携带情况,为医院感染防控提供实验依据;同时,分析碳青霉烯酶阳性组鲍曼不动杆菌的分子流行病学特点。方法:收集2013年10月至2014年8月临床标本中分离的鲍曼不动杆菌共133株,统计分析菌株临床分布情况;采用MicroScan WalkAway 96 Plus全自动微生物鉴定/药敏测试系统检测18种临床常用抗菌药物的药物敏感性试验,同时采用改良Hodge试验检测碳青霉烯酶表型,将133株鲍曼不动杆菌分为碳青霉烯酶阳性组和碳青霉烯酶阴性组;运用聚合酶链反应(Polymerase Chain Reaction,PCR)检测耐消毒剂基因qacE?1的总体携带情况,χ2检验比较分析碳青霉烯酶阳性组与碳青霉烯酶阴性组之间耐消毒剂基因qacE?1的携带率是否存在差异性;随机抽取qacE?1基因阳性菌株进行测序;运用重复序列PCR技术(repetitive element PCR,rep-PCR)分析碳青霉烯酶阳性组鲍曼不动杆菌的同源性。结果:133株临床分离鲍曼不动杆菌主要分离于痰标本,占73.7%,其次为分泌物标本,占13.5%;科室分布主要在重症监护病房(ICU)56株,占42.1%,其次是呼吸内科27株,占20.3%。药敏试验结果显示除对头孢哌酮/舒巴坦(29.3%)和复方新诺明(35.3%)的耐药率较低外,对其余16种临床常用的抗菌药物普遍耐药。改良Hodge试验将133株鲍曼不动杆菌分为两组,其中碳青霉烯酶阳性组97株,碳青霉烯酶阴性组36株。133株鲍曼不动杆菌中共检出112株qacE?1基因阳性菌株,总阳性携带率为84.2%,其中碳青霉烯酶阳性组中检出84株携带qacE?1基因,阳性携带率为86.6%,碳青霉烯酶阴性组中检出28株携带qacE?1基因,阳性携带率为77.8%。两组相比较,差异无统计学意义(P0.05)。随机抽取的qacE?1基因阳性标本的基因测序结果与GeneBank中相应基因序列相比较,同源性为98%。运用rep-PCR将碳青霉烯酶阳性组的鲍曼不动杆菌分为4个基因型,其中A型66株,为主要流行克隆株。结论:1、呼吸道是临床鲍曼不动杆菌感染的主要途径,且有较为明显的病区集中趋势。2、临床分离的鲍曼不动杆菌除对头孢哌酮/舒巴坦较为敏感外,对多种抗菌药物普遍耐药,耐药情况严峻。3、四川医科大学第一附属医院和四川省自贡市第一人民医院临床分离的133株鲍曼不动杆菌的耐消毒剂qacE?1基因携带率高,且与碳青霉烯酶表型无关。4、碳青霉烯酶阳性鲍曼不动杆菌以A型为主要感染流行。
[Abstract]:Objective: to analyze the clinical distribution of Acinetobacter baumannii isolated from the affiliated Hospital of the first Hospital of Sichuan Medical University and the first people's Hospital of Zigong City from October 2013 to August 2014. The production of carbapenem and the characteristics of resistance to 18 antimicrobial agents provide scientific basis for the rational use of antibiotics in clinic. The disinfectant resistant gene qacE of Acinetobacter baumannii was detected. 1) to provide experimental basis for the prevention and control of nosocomial infection; Meanwhile, the molecular epidemiological characteristics of Acinetobacter baumannii in carbapenem positive group were analyzed. Methods: 133 strains of Acinetobacter baumannii isolated from clinical specimens from October 2013 to August 2014 were collected. Statistical analysis of the clinical distribution of strains; MicroScan WalkAway 96 Plus automatic microbiological identification / drug sensitivity test system was used to detect the drug sensitivity of 18 kinds of commonly used antimicrobial agents in clinic. At the same time, 133 strains of Acinetobacter baumannii were divided into carbapenase positive group and carbapenem negative group by modified Hodge test. Polymerase chain reaction (PCR) was used to detect the disinfectant resistant gene qacE? (1) the total carrying status, 蠂 2 test, were compared to analyze the disinfectant resistance gene qacE between carbapenase positive group and carbapenem negative group. Is there any difference in carrying rate of Q1; random sampling of qacE? 1Gene positive strains were sequenced; Repetitive element PCR was used by repeated sequence PCR technique. Rep-PCR was used to analyze the homology of Acinetobacter baumannii in carbapenem positive group. Results 73.7% strains of Acinetobacter baumannii were isolated from sputum samples. The second was secretion specimen, accounting for 13.5; There were 56 ICUU strains in intensive care unit, accounting for 42.1%, followed by 27 strains in respiratory medicine department. The results of drug sensitivity test showed that the drug resistance rate was lower except for cefoperazone / sulbactam 29.3) and compound sulbactam 35.3B). The modified Hodge test divided 133 strains of Acinetobacter baumannii into two groups, 97 of which were carbapenase positive. A total of 112 strains of Acinetobacter baumannii were detected in the carbapenem negative group of 36 strains. 133 strains of Acinetobacter baumannii. The total positive rate was 84.2%, and 84 strains were found to carry qacE in the carbapenase positive group. 1 gene, the positive rate was 86. 6%, 28 strains were found to carry qacE in carbapenem negative group. 1 the positive rate of the gene was 77.8%. There was no significant difference between the two groups (P 0.05). 1 the results of gene sequencing in the positive samples were compared with the corresponding gene sequences in GeneBank. The homology was 98. Acinetobacter baumannii in carbapenem positive group was divided into 4 genotypes by rep-PCR. Respiratory tract is the main way of clinical Acinetobacter baumannii infection, and there is a more obvious trend of concentration. 2. Acinetobacter baumannii isolated clinically is sensitive to cefoperazone / sulbactam. Generally resistant to many kinds of antimicrobial agents, the situation of drug resistance is severe. 3. 133 strains of Acinetobacter baumannii were isolated from the first affiliated Hospital of Sichuan Medical University and the first people's Hospital of Zigong City Sichuan Province. 1 the gene carrying rate was high and had no correlation with carbapenem phenotype. Acinetobacter baumannii positive with carbapenem enzyme was the main type of infection in Acinetobacter baumannii.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

【参考文献】