ICU鲍曼不动杆菌碳青霉烯酶基因型研究
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摘要
目的分析重症监护病房(ICU)鲍曼不动杆菌耐药情况,研究其碳青霉烯酶基因型的流行情况。方法收集2016-2017年ICU分离得到的108株鲍曼不动杆菌。采用K-B纸片扩散法进行药物敏感试验。采用PCR法检测7种碳青霉烯酶基因,包括OXA-23、OXA-24、OXA-51、OXA-58、IMP-1、IMP-4和VIM-2。结果 108株鲍曼不动杆菌中碳青霉烯类耐药鲍曼不动杆菌(CRAB)的检出率从2016年的60.0%(24/40)上升到2017年的82.4%(56/68)。CRAB对多黏菌素B未见耐药(0.0%,0/80),对其他常见的抗菌药物耐药率均在96%左右。而非CRAB的耐药率均小于15%,与CRAB差别明显。碳青霉烯酶基因OXA-51的检出率为100.0%(108/108);OXA-23基因的检出率为63.0%(68/108),其中非CRAB未检出OXA-23基因(0/28),CRAB的OXA-23基因检出率为85.0%(68/80);其他OXA-24、OXA-58、IMP-1、IMP-4和VIM-2基因均未检出。结论 ICU的CRAB检出率上升明显且耐药现象严重;OXA-23基因在CRAB对碳青霉烯类药物耐药机制中起主要作用。
Objective To analyze the drug resistance situation of Acinetobacter baumannii in intensive care unit(ICU)and to study the prevalence situation of carbapenemase genotypes.Methods A total of 108 strains of Acinetobacter baumannii isolated from ICU during 2016-2017 were collected.The K-B disk diffusion method was used for conducting the drug sensitivity test.Seven carbapenemase genes,including OXA-23,OXA-24,OXA-51,OXA-58,IMP-1,IMP-4 and VIM-2 were detected by PCR.Results Among108 strains of Acinetobacter baumannii,the detection rate of carbapenem-resistant Acinetobacter baumannii(CRAB)was increased from 60.0%(24/40)in 2016 to 82.4%(56/68)in 2017.CRAB showed no resistance to polymyxin B,0.0%(0/80),and the resistance rate to other common antibacterial drugs was about 96%.The non-CRAB resistance rate was less than 15%,which was significantly different from CRAB.The detection rate of the carbapenemase gene OXA-51 was 100.0%(108/108);the detection rate of the OXA-23 gene was 63.0%(68/108),in which non-CRAB was not detected(0/28),CRAB′s OXA-23 gene detection rate was 85.0%(68/80);other OXA-24,OXA-58,IMP-1,IMP-4 and VIM-2 genes were not detected.Conclusion The detection rate of CRAB in ICU is increased significantly and drug resistance is serious.OXA-23 gene plays a major role in the mechanism of CRAB resistance to carbapenems.
Objective To analyze the drug resistance situation of Acinetobacter baumannii in intensive care unit(ICU)and to study the prevalence situation of carbapenemase genotypes.Methods A total of 108 strains of Acinetobacter baumannii isolated from ICU during 2016-2017 were collected.The K-B disk diffusion method was used for conducting the drug sensitivity test.Seven carbapenemase genes,including OXA-23,OXA-24,OXA-51,OXA-58,IMP-1,IMP-4 and VIM-2 were detected by PCR.Results Among108 strains of Acinetobacter baumannii,the detection rate of carbapenem-resistant Acinetobacter baumannii(CRAB)was increased from 60.0%(24/40)in 2016 to 82.4%(56/68)in 2017.CRAB showed no resistance to polymyxin B,0.0%(0/80),and the resistance rate to other common antibacterial drugs was about 96%.The non-CRAB resistance rate was less than 15%,which was significantly different from CRAB.The detection rate of the carbapenemase gene OXA-51 was 100.0%(108/108);the detection rate of the OXA-23 gene was 63.0%(68/108),in which non-CRAB was not detected(0/28),CRAB′s OXA-23 gene detection rate was 85.0%(68/80);other OXA-24,OXA-58,IMP-1,IMP-4 and VIM-2 genes were not detected.Conclusion The detection rate of CRAB in ICU is increased significantly and drug resistance is serious.OXA-23 gene plays a major role in the mechanism of CRAB resistance to carbapenems.
引文
[1]施腾飞,陈惠瑜,刘银环,等.福州地区碳青霉烯类耐药鲍曼不动杆菌碳青霉烯酶基因型研究[J].中国微生态学杂志,2017,29(2):155-158.
[2]刘仕莲,王燮辞,赵思阳.综合干预对ICU患者多重耐药菌感染的防控效果[J].预防医学情报杂志,2016,32(11):1230-1233.
[3]龙盛双,胡潇云,张啟鹏,等.2009-2013年某院重症监护病房常见细菌及耐药变迁[J].中国感染控制杂志,2016,15(8):542-547.
[4]陈海红,李华茵,何礼贤.耐碳青霉烯类鲍曼不动杆菌的耐药机制研究进展[J].中国呼吸与危重监护杂志,2010,9(4):439-443.
[5]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.
[6]贺毅.耐碳青霉烯类鲍曼不动杆菌耐酶机制及临床治疗的研究进展及其对策[J].抗感染药学,2017,14(4):725-729.
[7]KIM W Y,MOON J Y,HUH J W,et al.Comparable efficacy of tigecycline versus colistin therapy for MultidrugResistant and extensively drug-resistant acinetobacter baumannii pneumonia in critically ill patients[J].PLoSOne,2016,11(3):e0150642.
[8]QI LIHUA,LI HAO,ZHANG CHUANFU,et al.Relationship between Antibiotic Resistance,Biofilm Formation,and Biofilm-Specific Resistance in Acinetobacter baumannii[J].Front Microbiol,2016,7(483):483-487.
[9]LEE C R,LEE J H,PARK M,et al.Biology of acinetobacter baumannii:pathogenesis,antibiotic resistance mechanisms,and prospective treatment options[J].Front Cell Infect Microbiol,2017,7(55):55-59.
[10]陆丹倩,芮勇宇,杨秋,等.耐碳青霉烯类鲍曼不动杆菌的OXA酶基因研究[J].国际检验医学杂志,2016,37(22):3108-3110.
[11]AKBARI M,MAHDI A,NIAKAN M,et al.Rapid identification of Iranian Acinetobacter baumannii strains by single PCR assay using BLA oxa-51-like carbapenemase and evaluation of the antimicrobial resistance profiles of the isolates[J].Acta Microbiol Immunol Hung,2010,57(2):87-94.
[12]WARNER W A,KUANG S N,HERNANDEZ R,et al.Molecular characterization and antimicrobial susceptibility of Acinetobacter baumannii isolates obtained from two hospital outbreaks in Los Angeles County,California,USA[J].BMC Infect Dis,2016,16(1):194-198.
[13]MOLTER G,SEIFERT H,MANDRAKA F,et al.Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit:a multi-level strategic management approach[J].J Hosp Infect,2016,92(2):194-198.
[14]CHEON S,KIM M J,YUN S J,et al.Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control[J].Korean J Intern Med,2016,31(2):367-374.
[15]黄剑林,陈维贤.ICU病房下呼吸道多药耐药鲍曼不动杆菌感染高危因素,耐药性及预防措施研究[J].中国煤炭工业医学杂志,2016,19(9):1257-1260.
[2]刘仕莲,王燮辞,赵思阳.综合干预对ICU患者多重耐药菌感染的防控效果[J].预防医学情报杂志,2016,32(11):1230-1233.
[3]龙盛双,胡潇云,张啟鹏,等.2009-2013年某院重症监护病房常见细菌及耐药变迁[J].中国感染控制杂志,2016,15(8):542-547.
[4]陈海红,李华茵,何礼贤.耐碳青霉烯类鲍曼不动杆菌的耐药机制研究进展[J].中国呼吸与危重监护杂志,2010,9(4):439-443.
[5]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.
[6]贺毅.耐碳青霉烯类鲍曼不动杆菌耐酶机制及临床治疗的研究进展及其对策[J].抗感染药学,2017,14(4):725-729.
[7]KIM W Y,MOON J Y,HUH J W,et al.Comparable efficacy of tigecycline versus colistin therapy for MultidrugResistant and extensively drug-resistant acinetobacter baumannii pneumonia in critically ill patients[J].PLoSOne,2016,11(3):e0150642.
[8]QI LIHUA,LI HAO,ZHANG CHUANFU,et al.Relationship between Antibiotic Resistance,Biofilm Formation,and Biofilm-Specific Resistance in Acinetobacter baumannii[J].Front Microbiol,2016,7(483):483-487.
[9]LEE C R,LEE J H,PARK M,et al.Biology of acinetobacter baumannii:pathogenesis,antibiotic resistance mechanisms,and prospective treatment options[J].Front Cell Infect Microbiol,2017,7(55):55-59.
[10]陆丹倩,芮勇宇,杨秋,等.耐碳青霉烯类鲍曼不动杆菌的OXA酶基因研究[J].国际检验医学杂志,2016,37(22):3108-3110.
[11]AKBARI M,MAHDI A,NIAKAN M,et al.Rapid identification of Iranian Acinetobacter baumannii strains by single PCR assay using BLA oxa-51-like carbapenemase and evaluation of the antimicrobial resistance profiles of the isolates[J].Acta Microbiol Immunol Hung,2010,57(2):87-94.
[12]WARNER W A,KUANG S N,HERNANDEZ R,et al.Molecular characterization and antimicrobial susceptibility of Acinetobacter baumannii isolates obtained from two hospital outbreaks in Los Angeles County,California,USA[J].BMC Infect Dis,2016,16(1):194-198.
[13]MOLTER G,SEIFERT H,MANDRAKA F,et al.Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit:a multi-level strategic management approach[J].J Hosp Infect,2016,92(2):194-198.
[14]CHEON S,KIM M J,YUN S J,et al.Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control[J].Korean J Intern Med,2016,31(2):367-374.
[15]黄剑林,陈维贤.ICU病房下呼吸道多药耐药鲍曼不动杆菌感染高危因素,耐药性及预防措施研究[J].中国煤炭工业医学杂志,2016,19(9):1257-1260.