ICU分离鲍氏不动杆菌对碳青霉烯类抗菌药物耐药机制研究

发布时间：2019-04-03 20:38

【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。
[Abstract]:Objective to investigate the resistance mechanism of Acinetobacter baumannii isolated from (ICU) in intensive care unit (ICU) of hospital to carbapenems, and to provide a theoretical basis for the selection of antibiotics for the treatment of Acinetobacter baumannii infection in ICU. Methods A total of 135 strains of Acinetobacter baumannii isolated from inpatients with ICU from January 2010 to January 2014 were collected. VITEK-2Compact automatic microbiological analysis system was used for identification and drug sensitivity analysis. BlaVIM,blaNDM,blaOXA-23/24,blaIMP, was detected by PCR method. The carbapenase resistance genes such as blaKPC and blaOXA-51/58 were detected by PCR and linked to the carbapenase gene. Results one hundred and thirty-five strains of Acinetobacter baumannii were isolated in ICU for 4 years, and 52 strains (38.52%) of Acinetobacter baumannii isolated from 60-year-old patients were isolated. In sputum samples of ICU patients, 79 strains of Acinetobacter baumannii (58.52%) were detected, followed by secretions (20.00%) and urine (11.11%), followed by secretion (20.00%) and urine (11.11%). The highest resistance rate of Acinetobacter baumannii was 94.81% to ampicillin, 32.95% to meropenem and 34.07% to imipenem, respectively. The gene analysis of 46 strains of carbapenem-resistant bacteria showed that 46 strains carried blaOXA-51-like gene and 46 strains carried ISAba1 gene. 40 strains carrying blaOXA-23-like gene were identified as blaOXA-23 gene by sequencing blaOXA-23-like gene, and ISAba1-blaOXA-23 linkage gene was detected at the same time, blaKPC,blaIMP,blaVIM,blaOXA-58-like,blaOXA-24-like gene and blaNDM gene were not detected at the same time. Conclusion the drug resistance of Acinetobacter baumannii isolated from patients with ICU is serious, especially in the elderly, mainly isolated from sputum, among which carbapenem-resistant strains often carry the OXA- 23 carbapenase gene and are linked to ISAba1.
【作者单位】：金华市人民医院重症监护室;
【基金】：浙江省卫生厅医药卫生研究基金资助项目(2013KYA103)
【分类号】：R446.5

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