我院耐碳青霉烯鲍曼不动杆菌基因型分析
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摘要
目的分析佳木斯大学附属第一医院临床分离的鲍曼不动杆菌(Acinetobacter baumannii,AB)携带多重耐药相关基因β-内酰胺酶的情况,为临床合理应用抗菌药物提供理论依据。方法收集2013年9月—2015年6月佳木斯大学附属第一医院临床分离鲍曼不动杆菌110株,VITEK-II、Walkway-40全自动微生物鉴定/药敏测试系统菌种鉴定及药敏检测并进行16SrRNA鉴定;多重PCR检测鲍曼不动杆菌携带β-内酰胺酶(A、B、C、D类)的耐药基因。结果 110株鲍曼不动杆菌对头孢哌酮/舒巴坦、美洛培南、亚胺培南的耐药率较低(13. 3%、38. 5%、49. 3%)。D类碳青霉烯酶耐药基因:96株OXA-51 (87. 27%),53株OXA-23 (48. 18%),29株OXA-24(26. 36%),6株OXA-58(5. 45%)。金属酶:检出IMP 1株(0. 90%)和SIM 6株(5. 45%)。另检测出ADC 84株(76. 36%)、TEM 66株(60. 00%)、GES 16株(14. 54%)、PER 8株(7. 27%)、SHV 7株(6. 36%)、VEB 5株(4. 54%)。50株碳青霉烯类耐药的鲍曼不动杆菌中,OXA-23、OXA-51、OXA-24、ADC、TEM的检出率分别为84. 00%、92. 00%、26. 00%、92. 00%、88. 00%。碳青霉烯类耐药的鲍曼不动杆菌与碳青霉烯类敏感菌株比较OXA-23、ADC、TEM产酶基因的检出率差异具有统计学意义。结论产OXA、Amp C、ESBLs可能是我院鲍曼不动杆菌耐药的主要原因。
Objective To explore the distribution of β-Lactamase gene for resistance to β-lactamase antibiotics in Acinetobacter baumannii( A. baumannii) isolated from hospitalized patients in our hospital,and provide a reasonable basis for the clinical selection of antimicrobial drugs. Methods Total 110 strains of A. baumannii collected at the First Affiliated Hospital of Jiamusi University from September 2013 to June 2015 were tested for the bacteria identification and drug susceptibility by using the VITEK-II and Walkway-40 VITEK 2 COMPACT automatic microbiology analyzer. 16 S r RNA gene sequencing and multiplex PCR for identification of Ambler class A beta-lactamases were performed. Results The resistant rate of 110 A. baumannii samples to SCF,MEM and IMP were 13. 3%,38. 5% and 49. 3%,respectively. The Ambler class D beta-lactamases gene were as follows: 96 strains of OXA-53,OXA-23 strains( 48. 18%),29 strains OXA-24( 26. 36%),6 strains of OXA-58( 5. 45%),mainly OXA-51 and OXA-23; metal enzyme B included 1 strain of IMP( 0. 90%) and 6 strains of SIM( 5. 45%),84 strains of ADC( 76. 36%),66 strains of TEM( 60. 00%),16 strains of GES( 14. 54%),8 strains of PER( 7. 27%),7 strains of SHV( 6. 36%),and 5 strains of VEB( 4. 54%).Among 50 strains of carbapenem-resistant A. baumannii,the detection rate of OXA-23,OXA-51,OXA-24,ADC and TEM were 84. 00%,92. 00%,26. 00%,92. 00% and 88. 00%,respectively. When compared with carbapenem—sensitive A. baumannii, there was significant difference in the positive of CSAB OXA-23, ADC and TEM gene.Conclusion OXA,Amp C and extended spectrum β-Lactamase may be responsible for the resistance to β-lactamase antibiotics in A. baumannii in our hospital.
Objective To explore the distribution of β-Lactamase gene for resistance to β-lactamase antibiotics in Acinetobacter baumannii( A. baumannii) isolated from hospitalized patients in our hospital,and provide a reasonable basis for the clinical selection of antimicrobial drugs. Methods Total 110 strains of A. baumannii collected at the First Affiliated Hospital of Jiamusi University from September 2013 to June 2015 were tested for the bacteria identification and drug susceptibility by using the VITEK-II and Walkway-40 VITEK 2 COMPACT automatic microbiology analyzer. 16 S r RNA gene sequencing and multiplex PCR for identification of Ambler class A beta-lactamases were performed. Results The resistant rate of 110 A. baumannii samples to SCF,MEM and IMP were 13. 3%,38. 5% and 49. 3%,respectively. The Ambler class D beta-lactamases gene were as follows: 96 strains of OXA-53,OXA-23 strains( 48. 18%),29 strains OXA-24( 26. 36%),6 strains of OXA-58( 5. 45%),mainly OXA-51 and OXA-23; metal enzyme B included 1 strain of IMP( 0. 90%) and 6 strains of SIM( 5. 45%),84 strains of ADC( 76. 36%),66 strains of TEM( 60. 00%),16 strains of GES( 14. 54%),8 strains of PER( 7. 27%),7 strains of SHV( 6. 36%),and 5 strains of VEB( 4. 54%).Among 50 strains of carbapenem-resistant A. baumannii,the detection rate of OXA-23,OXA-51,OXA-24,ADC and TEM were 84. 00%,92. 00%,26. 00%,92. 00% and 88. 00%,respectively. When compared with carbapenem—sensitive A. baumannii, there was significant difference in the positive of CSAB OXA-23, ADC and TEM gene.Conclusion OXA,Amp C and extended spectrum β-Lactamase may be responsible for the resistance to β-lactamase antibiotics in A. baumannii in our hospital.
引文
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[5]张吉生,范学财,王勇,等.黑龙江东部地区鲍曼鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中国卫生检验杂志,2015,11(25):3956-3959.
[6]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Amp C酶的研究[J].中华医院感染学杂志,2016,26(4):727-729.
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[8] LIU W F,LIANG H W,LEE M F,et al. The impact of inadequate terminal disinfection on an outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit[J]. PLo S One,2014,9(9):e107975.
[9]龙鼎,喻莉,杨军辉.替加环素联合头孢哌酮舒巴坦钠治疗广泛耐药鲍曼不动杆菌老年肺部感染疗效观察[J].中华实用诊断与治疗杂志,2016,30(5):512-514.
[10] PIANA A,PALMIERI A,DEIDDA S,et al. Molecular typing of XDR Acinetobacter baumannii strains in an Italian ICU[J]. Epidemiol Prev,2015,39(4 Suppl 1):129-133.
[11]许磊,裘莉佩,王广芬,等.鲍曼不动杆菌外排泵基因与菌株多药耐药关系的研究[J].中国病原生物学杂志,2017,12(7):685-688.
[12] ALYAMANI E J,KHIYAMI M A,BOOQ R Y,et al. Molecular characterization of extended-spectrum beta-lactamases(ESBLs)produced by clinical isolates of Acinetobacter baumannii in Saudi Arabia[J].Ann Clin Microbiol Antimicrob,2015,14(1):38.
[13] BOCANEGRA-IBARIAS P,PENA-LOPEZ C,CAMACHO-ORTIZ A,et al. Genetic characterisation of drug resistance and clonal dynamics of Acinetobacter baumannii in a hospital setting in Mexico[J]. Int J Antimicrob Agents,2015,45(3):309-313.
[14] LIU Y,LIU X. Detection of Amp C beta-lactamases in Acinetobacter baumannii in the Xuzhou region and analysis of drug resistance[J].Exp Ther Med,2015,10(3):933-936.
[15]张吉生,王英,范学财.我院流行鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中华全科医学,2016,14(2):270-272.
[16] PERILLI M,SABATINI A,PONTIERI E,et al. OXA-23 carbapenemase in multidrug-resistant Acinetobacter baumannii ST2 type:first identification in L’Aquila Hospital(Italy)[J]. Microb Drug Resist,2015,21(1):97-101.
[2] HAMMOUDI D,MOUBARECK C A,HAKIME N,et al. Spread of imipenem-resistant Acinetobacter baumannii co-expressing OXA-23 and GES-11 carbapenemases in Lebanon[J]. Int J Infect Dis,2015,36(1):56-61.
[3] WANG H,WANG J,YU P,et al. Identification of antibiotic resistance genes in the multidrug-resistant Acinetobacter baumannii strain,MDRSHH02,using whole-genome sequencing[J]. Int J Mol Med,2017,39(2):364-372.
[4] HIGGINS P G,LEHMANN M,SEIFERT H. Inclusion of OXA-143primers in a multiplex polymerase chain reaction(PCR)for genes encoding prevalent OXA carbapenemases in Acinetobacter spp[J]. Int J Antimicrob Agents,2010,35(3):305.
[5]张吉生,范学财,王勇,等.黑龙江东部地区鲍曼鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中国卫生检验杂志,2015,11(25):3956-3959.
[6]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Amp C酶的研究[J].中华医院感染学杂志,2016,26(4):727-729.
[7] AHMED S S,ALP E,ULU-KILIC A,et al. Spread of carbapenem-resistant international clones of Acinetobacter baumannii in Turkey and Azerbaijan:a collaborative study[J]. Eur J Clin Microbiol Infect Dis,2016,35(9):1463-1468.
[8] LIU W F,LIANG H W,LEE M F,et al. The impact of inadequate terminal disinfection on an outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit[J]. PLo S One,2014,9(9):e107975.
[9]龙鼎,喻莉,杨军辉.替加环素联合头孢哌酮舒巴坦钠治疗广泛耐药鲍曼不动杆菌老年肺部感染疗效观察[J].中华实用诊断与治疗杂志,2016,30(5):512-514.
[10] PIANA A,PALMIERI A,DEIDDA S,et al. Molecular typing of XDR Acinetobacter baumannii strains in an Italian ICU[J]. Epidemiol Prev,2015,39(4 Suppl 1):129-133.
[11]许磊,裘莉佩,王广芬,等.鲍曼不动杆菌外排泵基因与菌株多药耐药关系的研究[J].中国病原生物学杂志,2017,12(7):685-688.
[12] ALYAMANI E J,KHIYAMI M A,BOOQ R Y,et al. Molecular characterization of extended-spectrum beta-lactamases(ESBLs)produced by clinical isolates of Acinetobacter baumannii in Saudi Arabia[J].Ann Clin Microbiol Antimicrob,2015,14(1):38.
[13] BOCANEGRA-IBARIAS P,PENA-LOPEZ C,CAMACHO-ORTIZ A,et al. Genetic characterisation of drug resistance and clonal dynamics of Acinetobacter baumannii in a hospital setting in Mexico[J]. Int J Antimicrob Agents,2015,45(3):309-313.
[14] LIU Y,LIU X. Detection of Amp C beta-lactamases in Acinetobacter baumannii in the Xuzhou region and analysis of drug resistance[J].Exp Ther Med,2015,10(3):933-936.
[15]张吉生,王英,范学财.我院流行鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中华全科医学,2016,14(2):270-272.
[16] PERILLI M,SABATINI A,PONTIERI E,et al. OXA-23 carbapenemase in multidrug-resistant Acinetobacter baumannii ST2 type:first identification in L’Aquila Hospital(Italy)[J]. Microb Drug Resist,2015,21(1):97-101.