近三年鲍曼不动杆菌耐药性变迁及外排泵基因研究
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摘要
目的研究鲍曼不动杆菌的耐药性变迁及外排泵基因携带情况,为控制医院感染提供依据。方法运用纸片扩散法检测我院2015-2017年临床分离的鲍曼不动杆菌对18种抗菌药物的耐药性,并对耐药性变化趋势进行分析。PCR技术检测多重耐药菌adeB、adeJ、adeE、abeM四种外排泵基因的携带情况。结果三年时间共分离出鲍曼不动杆菌385株,检出数量逐年升高,以呼吸科和重症医学科为主,分别占32.7%和28.3%。药敏结果显示鲍曼不动杆菌对多黏菌素B (0.0%)、替加环素(0.0%～1.6%)耐药率最低,其次为头孢哌酮舒巴坦(22.9%～32.0%)。三年来鲍曼不动杆菌对左氧氟沙星、亚胺培南、美罗培南耐药率有显著升高,超过20%,对庆大霉素、阿米卡星耐药率下降超过10%。172株多重耐药菌(44.7%)中,PCR扩增结果显示adeB和adeJ阳性率分别为76.7%和51.2%,并有5株(2.91%)检出adeE基因。结论近三年鲍曼不动杆菌耐药性呈上升趋势,外排泵是导致其耐药的机制之一。
Objective To explore the variation in drug resistance and efflux pump genes of Acinetobacter baumannii(A.baumannii)for control of nosocomial infections.Methods 385 strains of A.baumannii were isolated from patients in our hospital during 2015-2017.Their sensitivities to 18 antibiotics were tested by using disk diffusion method.The adeB,adeJ,adeE and abeM genes were detected by using PCR.Results The 385 strains of A.baumannii were mainly isolated from the respiratory department(32.7%,126/385)and ICU(28.3%,109/385).In the 3years the drug resistances to polymyxin B(0.0%)and tigecycline(0.0%～1.6%)were the lowest,followed by those to cefoperazone/sulbactam(22.9%～32.0%).From 2015to2017,the drug resistance rates to levofloxacin,imipenem and meropenem increased by over 20% while those to gentamicin and amikacin decreased by more than 10%.The positive rates of adeB and adeJ genes were 76.7%(132/172)and 51.2%(88/172),respectively.Moreover,adeE gene was detected in 5strains(2.91%).Conclusion The drug resistance of A.baumannii is on the rise during the latest three years.Efflux pump is one of the mechanisms leading to drug resistance.
Objective To explore the variation in drug resistance and efflux pump genes of Acinetobacter baumannii(A.baumannii)for control of nosocomial infections.Methods 385 strains of A.baumannii were isolated from patients in our hospital during 2015-2017.Their sensitivities to 18 antibiotics were tested by using disk diffusion method.The adeB,adeJ,adeE and abeM genes were detected by using PCR.Results The 385 strains of A.baumannii were mainly isolated from the respiratory department(32.7%,126/385)and ICU(28.3%,109/385).In the 3years the drug resistances to polymyxin B(0.0%)and tigecycline(0.0%～1.6%)were the lowest,followed by those to cefoperazone/sulbactam(22.9%～32.0%).From 2015to2017,the drug resistance rates to levofloxacin,imipenem and meropenem increased by over 20% while those to gentamicin and amikacin decreased by more than 10%.The positive rates of adeB and adeJ genes were 76.7%(132/172)and 51.2%(88/172),respectively.Moreover,adeE gene was detected in 5strains(2.91%).Conclusion The drug resistance of A.baumannii is on the rise during the latest three years.Efflux pump is one of the mechanisms leading to drug resistance.
引文
[1] 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,2017,7:55.
[2] CHEN Zhixiong,LIN Feng,LIN Yan,et al.The relationship between carbapenemase gene and carbapenem resistance of Acinetobacter baumannii[J].Chin J Microecol,2018,30(2):177-180.(in Chinese)陈志雄,林峰,林艳,等.鲍曼不动杆菌碳青霉烯酶基因分布与耐药相关性研究[J].中国微生态学杂志,2018,30(2):177-180.
[3]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2(8):3-8.
[4]张瑞丽.鲍曼不动杆菌对替加环素的敏感性研究[J].基层医学论坛,2017,21(31):4397-4398.
[5] HU Fupin,GUO Yan,ZHU Demei,et al.CHINET surveillance of bacterial resistance across China:report of the results in 2016[J].Chin J Infect Chemother,2017,17(5):481-491.(in Chinese)胡付品,郭燕,朱德妹,等.2016年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[6] QIU Zhuqiang,ZHU Lijing,LIU Cheng,et al.Changing antimicrobial resistance profile of Acinetobacter baumannii in Rushan People′s Hospital from 2013to 2015[J].Chin J Infect Chemother,2017,17(4):439-442.(in Chinese)仇祝强,祝丽晶,刘成,等.2013—2015年山东乳山市人民医院鲍曼不动杆菌耐药性监测[J].中国感染与化疗杂志,2017,17(4):439-442.
[7] HU Fupin.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Chin J Infect Chemother,2017,17(1):93-99.(in Chinese)胡付品.2005—2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[8] ZHANG Yuqiong,GAO Jingjing,LU Wenxiang,et al.Clinical distribution,drug resistance and drug-resistance genes of Acinetobacter baumannii in our hospital during 2014-2017[J].China Pharmacy,2018,29(6):794-799.(in Chinese)张宇琼,高晶晶,陆文香,等.我院2014-2017年鲍曼不动杆菌的临床分布、耐药性及耐药基因研究[J].中国药房,2018,29(6):794-799.
[9] Sieniawskik,Kaczka K,Rucin′ska M,et al.Acinetobacter baumannii nosocomial infection[J].Pol Przegl Chir,2013,85(9):483-490.
[10]侯盼飞,祝丽晶,宫凌娟,等.多重耐药鲍曼不动杆菌耐药性及AdeABC外排泵作用研究[J].中华临床医师杂志电子版,2012,6(19):6060-6062.
[11] Ardebili A,Lari AR,Talebi M.Correlation of ciprofloxacin resistance with the AdeABC efflux system in Acinetobacter baumannii clinical isolates[J].Ann Lab Med,2014,34(6):433-438.
[12] Abdalhamid B,Hassan H,Itbaileh A,et al.Characterization of carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Saudi Arabia[J].New Microbiol,2014,37(1):65-73.
[13] FANG Meizhi,CHEN Tingting,CAI Beibei,et al.Development of efflux pump mediated drug resistance among Acinetobacter baumannii[J].Chin J Clinicians(Electronic Edition),2016,10(2):256-259.(in Chinese)方美芝,陈婷婷,蔡贝贝,等.主动外排泵介导鲍曼不动杆菌耐药性研究进展[J].中华临床医师杂志(电子版),2016,10(2):256-259.
[14] Chau SL,Chu YW,Houang ET.Novel resistance-nodulationcell division efflux system AdeDE in Acinetobacter genomic DNA group 3[J].Antimicrob Agents Chemother,2004,48(10):4054-4055.
[15] Lin L,Ling BD,Li XZ.Distribution of the multidrug efflux pump genes,adeABC,adeDE and adeIJK,and class 1integron genes in multiple-antimicrobial-resistant clinical isolates of Acinetobacter baumannii-Acinetobacter calcoaceticus complex[J].Int J Antimicrob Agents,2009,33(1):27-32.
[16] Hou PF,Chen XY,Yan GF,et al.Study of the correlation of imipenem resistance with efflux pumps AdeABC,AdeIJK,AdeDE and AbeM in clinical isolates of Acinetobacter baumannii[J].Chemotherapy,2012,58(2):152-158.
[17] Deng M,Zhu MH,Li JJ,et al.Molecular epidemiology and mechanisms of tigecycline resistance in clinical isolates of Acinetobacter baumannii from a Chinese university hospital[J].Antimicrob Agents Chemother,2014,58(1):297-303.
[2] CHEN Zhixiong,LIN Feng,LIN Yan,et al.The relationship between carbapenemase gene and carbapenem resistance of Acinetobacter baumannii[J].Chin J Microecol,2018,30(2):177-180.(in Chinese)陈志雄,林峰,林艳,等.鲍曼不动杆菌碳青霉烯酶基因分布与耐药相关性研究[J].中国微生态学杂志,2018,30(2):177-180.
[3]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2(8):3-8.
[4]张瑞丽.鲍曼不动杆菌对替加环素的敏感性研究[J].基层医学论坛,2017,21(31):4397-4398.
[5] HU Fupin,GUO Yan,ZHU Demei,et al.CHINET surveillance of bacterial resistance across China:report of the results in 2016[J].Chin J Infect Chemother,2017,17(5):481-491.(in Chinese)胡付品,郭燕,朱德妹,等.2016年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[6] QIU Zhuqiang,ZHU Lijing,LIU Cheng,et al.Changing antimicrobial resistance profile of Acinetobacter baumannii in Rushan People′s Hospital from 2013to 2015[J].Chin J Infect Chemother,2017,17(4):439-442.(in Chinese)仇祝强,祝丽晶,刘成,等.2013—2015年山东乳山市人民医院鲍曼不动杆菌耐药性监测[J].中国感染与化疗杂志,2017,17(4):439-442.
[7] HU Fupin.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Chin J Infect Chemother,2017,17(1):93-99.(in Chinese)胡付品.2005—2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[8] ZHANG Yuqiong,GAO Jingjing,LU Wenxiang,et al.Clinical distribution,drug resistance and drug-resistance genes of Acinetobacter baumannii in our hospital during 2014-2017[J].China Pharmacy,2018,29(6):794-799.(in Chinese)张宇琼,高晶晶,陆文香,等.我院2014-2017年鲍曼不动杆菌的临床分布、耐药性及耐药基因研究[J].中国药房,2018,29(6):794-799.
[9] Sieniawskik,Kaczka K,Rucin′ska M,et al.Acinetobacter baumannii nosocomial infection[J].Pol Przegl Chir,2013,85(9):483-490.
[10]侯盼飞,祝丽晶,宫凌娟,等.多重耐药鲍曼不动杆菌耐药性及AdeABC外排泵作用研究[J].中华临床医师杂志电子版,2012,6(19):6060-6062.
[11] Ardebili A,Lari AR,Talebi M.Correlation of ciprofloxacin resistance with the AdeABC efflux system in Acinetobacter baumannii clinical isolates[J].Ann Lab Med,2014,34(6):433-438.
[12] Abdalhamid B,Hassan H,Itbaileh A,et al.Characterization of carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Saudi Arabia[J].New Microbiol,2014,37(1):65-73.
[13] FANG Meizhi,CHEN Tingting,CAI Beibei,et al.Development of efflux pump mediated drug resistance among Acinetobacter baumannii[J].Chin J Clinicians(Electronic Edition),2016,10(2):256-259.(in Chinese)方美芝,陈婷婷,蔡贝贝,等.主动外排泵介导鲍曼不动杆菌耐药性研究进展[J].中华临床医师杂志(电子版),2016,10(2):256-259.
[14] Chau SL,Chu YW,Houang ET.Novel resistance-nodulationcell division efflux system AdeDE in Acinetobacter genomic DNA group 3[J].Antimicrob Agents Chemother,2004,48(10):4054-4055.
[15] Lin L,Ling BD,Li XZ.Distribution of the multidrug efflux pump genes,adeABC,adeDE and adeIJK,and class 1integron genes in multiple-antimicrobial-resistant clinical isolates of Acinetobacter baumannii-Acinetobacter calcoaceticus complex[J].Int J Antimicrob Agents,2009,33(1):27-32.
[16] Hou PF,Chen XY,Yan GF,et al.Study of the correlation of imipenem resistance with efflux pumps AdeABC,AdeIJK,AdeDE and AbeM in clinical isolates of Acinetobacter baumannii[J].Chemotherapy,2012,58(2):152-158.
[17] Deng M,Zhu MH,Li JJ,et al.Molecular epidemiology and mechanisms of tigecycline resistance in clinical isolates of Acinetobacter baumannii from a Chinese university hospital[J].Antimicrob Agents Chemother,2014,58(1):297-303.