心脏外科鲍曼不动杆菌感染病原学特征分析
|
摘要
目的分析心脏外科鲍曼不动杆菌感染病原学,以指导临床诊疗。方法收集心脏外科感染鲍曼不动杆菌患者样本,K-B纸片法分析鲍曼不动杆菌的耐药性。PCR扩增检测耐药基因,统计学分析鲍曼不动杆菌产生耐药株的相关因素。结果从心脏外科患者样本分离87株鲍曼不动杆菌,呼吸道、手术切口、纵隔、血液、泌尿道及其他感染部位分别分离37、14、11、9、6和10株。鲍曼不动杆菌对头孢吡肟、头孢噻肟、头孢他啶、阿米卡星、亚胺培南、左氧氟沙星、环丙沙星、庆大霉素、氨苄西林、氨曲南的耐药率分别为55.17%、66.67%、68.97%、27.59%、28.74%、55.17%、50.57%、33.33%、65.52%和100.00%。鲍曼不动杆菌OXA-23基因、OXA-58基因、TEM基因、PER基因、IMP基因检出率分别为41.38%、8.05%、29.89%、10.34%和17.24%。鲍曼不动杆菌耐药与患者性别无关(χ~2=0.1010,P=0.7506),与年龄(χ~2=5.3454,P=0.0208)、合并糖尿病(χ~2=4.8619,P=0.0275)、住院天数(χ~2=8.7139,P=0.0032)、是否采用人工气道(χ~2=8.7139,P=0.0032)、抗生素使用(χ~2=9.2104,P=0.0024)相关。结论心脏外科鲍曼不动杆菌感染部位主要是呼吸道,病原菌对常用抗菌药物都产生了一定程度的耐药性,耐药性发展可能与耐药基因的传播关系密切。临床应注意合理用药。
Objectives To analyze the etiology of Acinetobacter baumannii infections in Cardiac Surgery in order to guide the treatment of this condition. Methods Samples from patients in Cardiac Surgery who were infected with A. baumannii were collected, and the drug resistance of A. baumannii was analyzed using the K-B method. Drug resistance genes were detected via amplification with PCR, and factors related to the multi-drug resistance of A. baumannii were statistically analyzed. Results Eighty-seven strains of A. baumannii were isolated from 177 patient samples. Thirty-seven strains were isolated from the respiratory tract, 14 were isolated from surgical wounds, 11 were isolated from the mediastinum, 9 were isolated from blood, 6 were isolated from the urinary tract, and 10 were isolated from some other site. The resistance of A. baumannii to cefepime was 55.17%, its resistance to cefotaxime was 66.67%, its resistance to ceftazidime was 68.97%, its resistance to amikacin was 27.59%, its resistance to imipenem was 28.74%, its resistance to levofloxacin was 55.17%, its resistance to ciprofloxacin was 50.57%, its resistance to gentamicin was 33.33%, its resistance to ampicillin was 65.52%, and its resistance to aztreonam was 100.00%. The oxa-23 gene was detected in 41.38% of strains, the oxa-58 gene was detected in 8.05%, the TEM gene was detected in 29.89%, the PER gene was detected in 10.34%, and the IMP gene was detected in 17.24%. Multi-drug-resistant strains of A. baumannii were not associated with gender(χ~2=0.1010, P=0.7506), There were significant differences in terms of age(χ~2=5.3454, P=0.0208), diabetes mellitus(χ~2=4.8619, P=0.0275), duration of hospitalization(χ~2=8.7139, P=0.0032), whether an artificial airway was created(χ~2=8.7139, P=0.0032), and antibiotic use(χ~2=9.2104, P=0.0024). Conclusion The main site of A. baumannii infection in Cardiac Surgery is the respiratory tract, and the bacterium has developed a certain degree of resistance to commonly used antimicrobials. Its development of drug resistance may be closely related to the spread of drug resistance genes. Drugs should be used rationally in clinical practice.
Objectives To analyze the etiology of Acinetobacter baumannii infections in Cardiac Surgery in order to guide the treatment of this condition. Methods Samples from patients in Cardiac Surgery who were infected with A. baumannii were collected, and the drug resistance of A. baumannii was analyzed using the K-B method. Drug resistance genes were detected via amplification with PCR, and factors related to the multi-drug resistance of A. baumannii were statistically analyzed. Results Eighty-seven strains of A. baumannii were isolated from 177 patient samples. Thirty-seven strains were isolated from the respiratory tract, 14 were isolated from surgical wounds, 11 were isolated from the mediastinum, 9 were isolated from blood, 6 were isolated from the urinary tract, and 10 were isolated from some other site. The resistance of A. baumannii to cefepime was 55.17%, its resistance to cefotaxime was 66.67%, its resistance to ceftazidime was 68.97%, its resistance to amikacin was 27.59%, its resistance to imipenem was 28.74%, its resistance to levofloxacin was 55.17%, its resistance to ciprofloxacin was 50.57%, its resistance to gentamicin was 33.33%, its resistance to ampicillin was 65.52%, and its resistance to aztreonam was 100.00%. The oxa-23 gene was detected in 41.38% of strains, the oxa-58 gene was detected in 8.05%, the TEM gene was detected in 29.89%, the PER gene was detected in 10.34%, and the IMP gene was detected in 17.24%. Multi-drug-resistant strains of A. baumannii were not associated with gender(χ~2=0.1010, P=0.7506), There were significant differences in terms of age(χ~2=5.3454, P=0.0208), diabetes mellitus(χ~2=4.8619, P=0.0275), duration of hospitalization(χ~2=8.7139, P=0.0032), whether an artificial airway was created(χ~2=8.7139, P=0.0032), and antibiotic use(χ~2=9.2104, P=0.0024). Conclusion The main site of A. baumannii infection in Cardiac Surgery is the respiratory tract, and the bacterium has developed a certain degree of resistance to commonly used antimicrobials. Its development of drug resistance may be closely related to the spread of drug resistance genes. Drugs should be used rationally in clinical practice.
引文
[1] Longo B.Molecular findings and antibiotic-resistance in an outbreak of Acinetobacter baumanii in an intensive care unit[J].Ann Ist Super Sanita,2007,43(1):83-8.
[2] 陈鸣敏.心外科手术术后医院感染危险因素分析[J].中华医院感染学杂志,2013,23(3):547-9.
[3] 周丹,陶凉,陈绪发,等.心脏外科术后患者深部胸骨切口感染的临床特征与病原菌分布及耐药性研究[J].中华医院感染学杂志,2107,27(5):1117-9.
[4] Peleg AY,Seifert H,Paterson DL.Acinembacter baumannii emergence of a successful pathogens[J].Clin Microbiol Rev,2008(21):538-82.
[5] Alzal-Shah M,Woodford N,Livemore DM.Characterization of OXA-25,OXA-26,and OXA-27,molecular class D beta-lactamases associated with carbapenem resistance in clinical isolates of Acinetobacter baumannii[J].Antimicrob Agentes Chemother,2001,45(2):583-8.
[6] 史芳涛.心脏外科术后医院感染及其危险因素探讨分析[J].医药论坛杂志,2016,37(1):91-3.
[7] 刘冬,王文璋,蔡爱兵,等.心脏手术后深部胸骨切口感染修复与重建189例临床分析[J].中华外科杂志,2015,65(3):193-6.
[8] 马加贵,安建雄,王文璋,等.心脏外科术后不同类型深部胸骨切口感染的临床表现及病原学特点[J].中国医科大学学报,2016,45(7):635-40.
[9] Beggs CB,Kerr KG,Snelling AM,et al.Acinetobcter spp and the clinical environment[J].Indoor Built Environ,2006,15(1):19.
[10] Peleg AY,Seifert H,Paterson DL.Acinetobacter baumannii:emergence of a successful pathogen[J].Clin Microbiol Rev,2008,21(3):538-82.
[11] Gogou V,Pournaras S,Giannouli M,et al.Evolution of multidrug-resistant Acinetobacter baumannii clonal lineages:a 10 year study in Greece (2000-09) [J].J Antimicrob Chemother,2011,66(12):2767-72.
[12] 姜丽,贾萌,高飞,等.血流感染泛耐药鲍曼不动杆菌耐药和基因型分析[J].中国病原生物学杂志,2018,13(4):424-7.
[13] 李喜元,马加贵,尹吉东,等.深部胸骨切口感染的研究进展[J].医学综述,2014,20(22):4122-6.
[14] 刘青松,孙静娜,代丽丽,等.鲍曼不动杆菌的耐药机制研究进展[J].中国微生态学杂志,2015,27(1):108-11.
[15] 杨燕,肖慈然,邹玖明,等.多重耐药鲍曼不动杆菌β-内酰胺类耐药基因研究[J].中国感染控制杂志,2015,14(10):658-62.
[2] 陈鸣敏.心外科手术术后医院感染危险因素分析[J].中华医院感染学杂志,2013,23(3):547-9.
[3] 周丹,陶凉,陈绪发,等.心脏外科术后患者深部胸骨切口感染的临床特征与病原菌分布及耐药性研究[J].中华医院感染学杂志,2107,27(5):1117-9.
[4] Peleg AY,Seifert H,Paterson DL.Acinembacter baumannii emergence of a successful pathogens[J].Clin Microbiol Rev,2008(21):538-82.
[5] Alzal-Shah M,Woodford N,Livemore DM.Characterization of OXA-25,OXA-26,and OXA-27,molecular class D beta-lactamases associated with carbapenem resistance in clinical isolates of Acinetobacter baumannii[J].Antimicrob Agentes Chemother,2001,45(2):583-8.
[6] 史芳涛.心脏外科术后医院感染及其危险因素探讨分析[J].医药论坛杂志,2016,37(1):91-3.
[7] 刘冬,王文璋,蔡爱兵,等.心脏手术后深部胸骨切口感染修复与重建189例临床分析[J].中华外科杂志,2015,65(3):193-6.
[8] 马加贵,安建雄,王文璋,等.心脏外科术后不同类型深部胸骨切口感染的临床表现及病原学特点[J].中国医科大学学报,2016,45(7):635-40.
[9] Beggs CB,Kerr KG,Snelling AM,et al.Acinetobcter spp and the clinical environment[J].Indoor Built Environ,2006,15(1):19.
[10] Peleg AY,Seifert H,Paterson DL.Acinetobacter baumannii:emergence of a successful pathogen[J].Clin Microbiol Rev,2008,21(3):538-82.
[11] Gogou V,Pournaras S,Giannouli M,et al.Evolution of multidrug-resistant Acinetobacter baumannii clonal lineages:a 10 year study in Greece (2000-09) [J].J Antimicrob Chemother,2011,66(12):2767-72.
[12] 姜丽,贾萌,高飞,等.血流感染泛耐药鲍曼不动杆菌耐药和基因型分析[J].中国病原生物学杂志,2018,13(4):424-7.
[13] 李喜元,马加贵,尹吉东,等.深部胸骨切口感染的研究进展[J].医学综述,2014,20(22):4122-6.
[14] 刘青松,孙静娜,代丽丽,等.鲍曼不动杆菌的耐药机制研究进展[J].中国微生态学杂志,2015,27(1):108-11.
[15] 杨燕,肖慈然,邹玖明,等.多重耐药鲍曼不动杆菌β-内酰胺类耐药基因研究[J].中国感染控制杂志,2015,14(10):658-62.