临床多药耐药鲍氏不动杆菌分布及β-内酰胺酶基因型分析
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摘要
目的调查多药耐药鲍氏不动杆菌的分布及β-内酰胺酶耐药基因的流行情况。方法收集2017年6月-8月安徽省立医院住院患者标本中分离得到的多药耐药鲍氏不动杆菌(Multidrug-resistant Acinetobacter baumannii,MDRAB)菌株。采用VITEK-2COMPACT全自动微生物分析仪进行菌株鉴定及药敏试验。应用PCR法检测β-内酰胺酶耐药基因。结果 71例多药耐药鲍氏不动杆菌主要来自ICU占67.6%,大多来源于痰标本占84.5%。对10种常用抗菌药物耐药率为79.4%～100.0%,其中对头孢菌素类、环丙沙星以及亚胺培南的耐药率均为100.0%。检测出的β-内酰胺酶耐药基因有blaOXA-23(90.1%,64例)、blaTEM(66.2%,47例)、blaKPC(1.4%,1例)和blaSHV(1.4%,1例),其中1例菌株同时携带blaKPC、blaSHV以及blaTEM三个耐药基。结论医院多药耐药鲍氏不动杆菌情况较严重,β-内酰胺酶相关耐药基因广泛存在于多药耐药鲍氏不动杆菌中,多药耐药鲍氏不动杆菌对β-内酰胺类抗菌药物耐药可能与β-内酰胺酶耐药基因表达相关。
OBJECTIVE To investigate the distribution of multidrug-resistant Acinetobacter baumannii(MDRAB)strains and analyze the prevalence ofβ-lactamase drug resistance genes.METHODS The MDRAB strains were isolated from the specimens of the patients who were hospitalized in Affiliated Provincial Hospital of Anhui Medical University from Jun 2017 to Aug 2017,the isolated strains were identified by using VITEK-2 COMPACT automatic microorganism analyzer,the drug susceptibility testing was performed,and theβ-lactamase drug resistance genes were detected with the use of PCR.RESULTS Of 71 strains of MDRAB,67.6% were isolated from ICU,84.5% of which were isolated from sputum specimens.The drug resistance rates of the strains to the 10 types of commonly used antibiotics varied from 79.4%to 100.0%,the drug resistance rates to cephalosporins,ciprofloxacin and imipenem were 100.0%.Among the strains that were detected with theβ-lactamase drug resistance genes,64(90.1%)were detected with blaOXA-23,47(66.2%)were detected with blaTEM,1(1.4%)was detected with blaKPC,and 1(1.4%)was detected with blaSHV,and 1 was carried with blaKPC,blaSHVand blaTEM.CONCLUSION The MDRAB strains are highly drug-resistant,theβ-lactamase drug resistance genes are prevalent among the MDRAB strains,and the drug resistance of the MDRAB strains to theβ-lactams antibiotics may be related to the expression of theβ-lactamase drug resistance genes.
OBJECTIVE To investigate the distribution of multidrug-resistant Acinetobacter baumannii(MDRAB)strains and analyze the prevalence ofβ-lactamase drug resistance genes.METHODS The MDRAB strains were isolated from the specimens of the patients who were hospitalized in Affiliated Provincial Hospital of Anhui Medical University from Jun 2017 to Aug 2017,the isolated strains were identified by using VITEK-2 COMPACT automatic microorganism analyzer,the drug susceptibility testing was performed,and theβ-lactamase drug resistance genes were detected with the use of PCR.RESULTS Of 71 strains of MDRAB,67.6% were isolated from ICU,84.5% of which were isolated from sputum specimens.The drug resistance rates of the strains to the 10 types of commonly used antibiotics varied from 79.4%to 100.0%,the drug resistance rates to cephalosporins,ciprofloxacin and imipenem were 100.0%.Among the strains that were detected with theβ-lactamase drug resistance genes,64(90.1%)were detected with blaOXA-23,47(66.2%)were detected with blaTEM,1(1.4%)was detected with blaKPC,and 1(1.4%)was detected with blaSHV,and 1 was carried with blaKPC,blaSHVand blaTEM.CONCLUSION The MDRAB strains are highly drug-resistant,theβ-lactamase drug resistance genes are prevalent among the MDRAB strains,and the drug resistance of the MDRAB strains to theβ-lactams antibiotics may be related to the expression of theβ-lactamase drug resistance genes.
引文
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[15]黄支密,毛培华,陈榆,等.鲍氏不动杆菌SHV型β-内酰胺酶耐药基因分子流行病学研究[J].中华流行病学杂志,2004,25(5):425-427.
[16] Jeong S,Kim JO,Yoon EJ,et al.Extensively drug-resistant Escherichia coli sequence type 1642carrying an IncX3plasmid containing the blaKPC-2gene associated with transposon Tn4401a[J].Ann Lab Med,2018,38(1):17-22.
[17] Brkic DV,Pristas I,Cipris I,et al.Successful containment of the first KPC-producing Klebsiella pneumoniae outbreak in Croatia[J].Future Microbiol,2017,12:967-974.
[2] Tan Y,Zhou K,Tang X,et al.Bacteremic and non-bacteremic pneumonia caused by Acinetobacter baumannii in ICUs of South China:a clinical and microbiological study[J].Sci Rep,2017,7(1):15279.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:58-83.
[5] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-fourth informational supplement.CLSI document M100-S24[S].Wayne,PA:CLSI,2014.
[6]贾莉萍,王洪江,刘欣波,等.北京某三级甲等医院多药耐药菌检出分析[J].中华医院感染学杂志,2018,28(16):2470-2473.
[7] Bozorgmehr R,Bahrani V,Fatemi A.Ventilator-associated pneumonia and its responsible germs;an epidemiological study[J].Emerg(Tehran),2017,5(1):e26.
[8]邱瑶雪,李家斌,程君,等.2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析[J].中华医院感染学志,2017,27(5):980-983.
[9] Tran GM,Ho-Le TP,Ha DT,et al.Patterns of antimicrobial resistance in intensive care unit patients:a study in Vietnam[J].BMC Infect Dis,2017,17(1):429.
[10] Mohammadi M,Soroush S,Delfani S,et al.Distribution of class D carbapenemase and extended-spectrumβ-lctamase gnes among Acinetobacter bumannii isolated from burn wound and ventilator-associated pneumonia infections[J].J Clin Diagn Res,2017,11(7):DC19-DC23.
[11] Ben RJ,Yang MC,Hsueh JC,et al.Molecular characterisation of multiple drug-resistant Acinetobacter baumannii isolates in southern Taiwan[J].Int J Antimicrob Agents,2011,38(5):403-408.
[12] Zahedi Bialvaei A,Samadi Kafil H,Ebrahimzadeh Leylabadlo H,et al.Dissemination of carbapenemases producing gram-negative bacteria in the Middle East[J].Iran J Microbiol,2015,7(5):226-246.
[13] Robledo IE,Aquino EE,Sante MI,et al.Detection of KPC in Acinetobacter spp.in Puerto Rico[J].Antimicrob Agents Chemother,2010,54(3):1354-1357.
[14] Robledo IE,Aquino EE,Vazquez GJ.Detection of the KPC gene in Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii during a PCR-based nosocomial surveillance study in Puerto Rico[J].Antimicrob Agents Chemother,2011,55(6):2968-2970.
[15]黄支密,毛培华,陈榆,等.鲍氏不动杆菌SHV型β-内酰胺酶耐药基因分子流行病学研究[J].中华流行病学杂志,2004,25(5):425-427.
[16] Jeong S,Kim JO,Yoon EJ,et al.Extensively drug-resistant Escherichia coli sequence type 1642carrying an IncX3plasmid containing the blaKPC-2gene associated with transposon Tn4401a[J].Ann Lab Med,2018,38(1):17-22.
[17] Brkic DV,Pristas I,Cipris I,et al.Successful containment of the first KPC-producing Klebsiella pneumoniae outbreak in Croatia[J].Future Microbiol,2017,12:967-974.