多重耐药鲍氏不动杆菌耐药性及部分耐药基因检测
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摘要
目的研究多重耐药鲍氏不动杆菌(MDR-AB)流行病学特征、耐药性及部分耐药基因阳性率。方法留取2016年7月-2017年2月于医院住院患者送检标本中分离的64株MDR-AB,统计流行病学特征,检测对15种抗菌药物的敏感性,并采用PCR技术检测TEM、ADC、OXA-23、OXA-51、ISAba1、armA、ant(3″)-Ⅰ、aac(3)-Ⅰ、aac(6′)-Ⅰ、sul1、sul2耐药基因的携带情况。结果 64株MDR-AB中,科室分布以急诊ICU为主,15株占23.44%,其次为ICU、脑中心ICU;标本来源以痰标本为主,48株占75.00%,其次为分泌物;对哌拉西林、头孢吡肟、头孢他啶、头孢曲松、哌拉西林/他唑巴坦、美罗培南、亚胺培南全部耐药,对复方新诺明的耐药性最低;以上耐药基因均有检出,β-内酰胺酶耐药基因阳性率均>80%,其中OXA-51、ISAba1基因的检出率为100.00%,氨基糖苷类修饰酶耐药基因中ant(3″)-Ⅰ的阳性率>70%,aac(3)-Ⅰ、aac(6′)-Ⅰ阳性率则较低。结论医院MDRAB耐药性强,耐药与所检测11种耐药基因有关,应进一步促进抗菌药物的合理应用。
OBJECTIVE To investigate the epidemiological characteristics,drug resistance and positive rate of resistant genes of multidrug-resistant Acinetobacter baumannii(MDR-AB).METHODS The clinical isolates of 64 strains of MDR-AB from hospitalized patients from Jul.2016 to Feb.2017 were collected.Epidemiological characteristics were statistically analyzed,the sensitivities to 15 kinds of antibiotics were detected,and PCR was used to detect the expressions of TEM,ADC,OXA-23,OXA-51,ISAba1,armA,ant(3″)-Ⅰ,aac(3)-Ⅰ,aac(6′)-Ⅰ,sul1 and sul2.RESULTS Among the 64 strains of MDR-AB,the departments were mainly distributed in emergency ICU,which were 15 strains accounting for 23.44%,followed by ICU and brain center ICU.The samples were mainly sputum specimens,which were 48 strains accounting for 75.00%,followed by secretions.They were all resistant to piperacillin,cefepime,ceftazidime,ceftriaxone,piperacillin/tazobactam,meropenem and imipenem,and the drug resistance to compound sulfamethoxazole was the lowest.All the resistant genes were detected.The positive rate ofβ-lactamase resistance gene was>80%,and the detection rates of OXA-51 and ISAba1 genes were 100.00%.The positive rate of ant(3″)-Ⅰin the aminoglycoside modifying enzyme resistance gene>70%,and the positive rates of aac(3)-Ⅰ and aac(6′)-Ⅰ were lower.CONCLUSION The drug resistance of MDR-AB in our hospital is strong.Drug resistance is related to the detected 11 kinds of resistant genes,and further rational use of antibiotics should be promoted.
OBJECTIVE To investigate the epidemiological characteristics,drug resistance and positive rate of resistant genes of multidrug-resistant Acinetobacter baumannii(MDR-AB).METHODS The clinical isolates of 64 strains of MDR-AB from hospitalized patients from Jul.2016 to Feb.2017 were collected.Epidemiological characteristics were statistically analyzed,the sensitivities to 15 kinds of antibiotics were detected,and PCR was used to detect the expressions of TEM,ADC,OXA-23,OXA-51,ISAba1,armA,ant(3″)-Ⅰ,aac(3)-Ⅰ,aac(6′)-Ⅰ,sul1 and sul2.RESULTS Among the 64 strains of MDR-AB,the departments were mainly distributed in emergency ICU,which were 15 strains accounting for 23.44%,followed by ICU and brain center ICU.The samples were mainly sputum specimens,which were 48 strains accounting for 75.00%,followed by secretions.They were all resistant to piperacillin,cefepime,ceftazidime,ceftriaxone,piperacillin/tazobactam,meropenem and imipenem,and the drug resistance to compound sulfamethoxazole was the lowest.All the resistant genes were detected.The positive rate ofβ-lactamase resistance gene was>80%,and the detection rates of OXA-51 and ISAba1 genes were 100.00%.The positive rate of ant(3″)-Ⅰin the aminoglycoside modifying enzyme resistance gene>70%,and the positive rates of aac(3)-Ⅰ and aac(6′)-Ⅰ were lower.CONCLUSION The drug resistance of MDR-AB in our hospital is strong.Drug resistance is related to the detected 11 kinds of resistant genes,and further rational use of antibiotics should be promoted.
引文
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[8]郭宇航,范学财,张吉生,等.ICU患者感染泛耐药鲍氏不动杆菌携带OXA酶与AmpC酶的研究[J].中华医院感染学杂志,2016,26(4):727-729.
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[10]Lee CR,Lee JH,Park M,et al.Biology of Acinetobacter baumannii:pathogenesis,antibiotic resistance mechanisms,and prospective treatment options[J].Front Cell Infect Microbiol,2017(7):e55.
[11]杨艳,王厚照,张玲.多重耐药鲍曼不动杆菌耐药性及β-内酰胺酶耐药基因的研究[J].微生物学杂志,2015,35(4):54-58.
[12]Li H,Liu F,Zhang Y,et al.Evolution of carbapenem-resistant Acinetobacter baumannii revealed through whole-genome sequencing and comparative genomic analysis[J].Antimicrob Agents Chemother,2015,59(2):1168-1176.
[13]张春玲,陈慧红,牛津,等.碳青霉烯类抗菌药物耐药鲍氏不动杆菌分布和耐药基因检测[J].中华医院感染学杂志,2017,27(1):24-27.
[14]Ruan Z,Chen Y,Jiang Y,et al.Wide distribution of CC92carbapenem-resistant and OXA-23-producing Acinetobacter baumannii in multiple provinces of China[J].Int J Antimicrob Agents,2013,42(4):322-328.
[15]Gholami M,Haghshenas M,Moshiri M,et al.Frequency of16SrRNA methylase and aminoglycoside-modifying enzyme genes among clinical isolates of Acinetobacter baumannii in Iran[J].Iran J Pathol,2017,12(4):329-338.
[16]薛万华,刘静,牟云清,李仁哲.院内多重耐药鲍曼不动杆菌的分布及氨基糖苷类耐药基因的研究[J].中华实验和临床感染病杂志(电子版),2015,9(4):506-509.
[17]王莹,汪鹏程,曾章锐,等.Vitek2Compact全自动微生物仪检测鲍氏不动杆菌对阿米卡星敏感性误差的原因[J].临床检验志,2013,31(1):28-31.
[18]Viehman JA,Nguyen MH,Doi Y.Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections[J].Drugs,2014,74(12):1315-
[2]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.
[3]Sun W,Weingarten RA,Xu M,et al.Rapid antimicrobial susceptibility test for identification of new therapeutics and drug combinations against multidrug-resistant bacteria[J].Emerg Microbes Infect,2016,5(11):e116.
[4]吴春苏,汪艳,盛瑞玲,等.多药耐药鲍氏不动杆菌的临床分布特点及耐药性监测分析[J].中华医院感染学杂志,2017,27(4):732-734.
[5]Maraki S,Mantadakis E,Mavromanolaki VE,et al.A 5-year surveillance study on antimicrobial resistance of Acinetobacterbaumanniiclinical isolates from a tertiary Greek hospital[J].Infect Chemother,2016,48(3):190-198.
[6]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susuceptibility testing[S].Twenty-sixth Informational Suplement,2016:M100-S26.
[7]陈璐,李凌竹,刘宝,等.耐碳青霉烯鲍氏不动杆菌耐药性与耐药基因检出关系探[J].中华医院感染学杂志,2016,26(17):3848-3851.
[8]郭宇航,范学财,张吉生,等.ICU患者感染泛耐药鲍氏不动杆菌携带OXA酶与AmpC酶的研究[J].中华医院感染学杂志,2016,26(4):727-729.
[9]李娜,黄艳芳,唐喻莹,等.多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析[J].中国感染控制杂志,2017,16(2):115-120.
[10]Lee CR,Lee JH,Park M,et al.Biology of Acinetobacter baumannii:pathogenesis,antibiotic resistance mechanisms,and prospective treatment options[J].Front Cell Infect Microbiol,2017(7):e55.
[11]杨艳,王厚照,张玲.多重耐药鲍曼不动杆菌耐药性及β-内酰胺酶耐药基因的研究[J].微生物学杂志,2015,35(4):54-58.
[12]Li H,Liu F,Zhang Y,et al.Evolution of carbapenem-resistant Acinetobacter baumannii revealed through whole-genome sequencing and comparative genomic analysis[J].Antimicrob Agents Chemother,2015,59(2):1168-1176.
[13]张春玲,陈慧红,牛津,等.碳青霉烯类抗菌药物耐药鲍氏不动杆菌分布和耐药基因检测[J].中华医院感染学杂志,2017,27(1):24-27.
[14]Ruan Z,Chen Y,Jiang Y,et al.Wide distribution of CC92carbapenem-resistant and OXA-23-producing Acinetobacter baumannii in multiple provinces of China[J].Int J Antimicrob Agents,2013,42(4):322-328.
[15]Gholami M,Haghshenas M,Moshiri M,et al.Frequency of16SrRNA methylase and aminoglycoside-modifying enzyme genes among clinical isolates of Acinetobacter baumannii in Iran[J].Iran J Pathol,2017,12(4):329-338.
[16]薛万华,刘静,牟云清,李仁哲.院内多重耐药鲍曼不动杆菌的分布及氨基糖苷类耐药基因的研究[J].中华实验和临床感染病杂志(电子版),2015,9(4):506-509.
[17]王莹,汪鹏程,曾章锐,等.Vitek2Compact全自动微生物仪检测鲍氏不动杆菌对阿米卡星敏感性误差的原因[J].临床检验志,2013,31(1):28-31.
[18]Viehman JA,Nguyen MH,Doi Y.Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections[J].Drugs,2014,74(12):1315-