重症监护病房耐碳青霉烯鲍氏不动杆菌耐药性及基因同源性分析
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摘要
目的研究绍兴市中心医院ICU住院患者临床分离的耐碳青霉烯类鲍氏不动杆菌的耐药性和基因分型。方法收集2016年绍兴市中心医院ICU住院患者临床分离的耐碳青霉烯类鲍氏不动杆菌60株。微量稀释法进行常规药敏试验。采用多重PCR技术检测菌株携带的耐药基因,PFGE分型技术对鲍氏不动杆菌进行基因同源性分析。结果抗菌药物敏感性试验显示所有菌株具有多药耐药性,对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟耐药率>90%,对阿米卡星的敏感率较高为62.4%,其次为头孢哌酮/舒巴坦和左氧氟沙星;PCR检出60株鲍氏不动杆菌均为OXA-23型和OXA-51型。PFGE分型均为同一型别。结论绍兴市中心医院ICU分离的耐碳青霉烯鲍氏不动杆菌的耐药基因为OXA-23型和OXA-51型,为同一来源,考虑为医院感染所致,因此应采取有效措施来控制该耐药株的传播。
OBJECTIVE To investigate the drug resistance and genotypes of carbapenem-resistant Acinetobacter baumannii strains isolated from the patients who were hospitalized in the ICUs of the Centre Hospital Shaoxing City Zhejiang Province.METHODS A total of 60 strains of carbapenem-resistant A.baumannii were isolated from the patients who were hospitalized in the ICUs of the Centre Hospital Shaoxing City Zhejiang Province,the routine drug susceptibility testing was performed by using microdilution method,the drug resistance genes that were carried by strains were detected by means of multiple PCR technique,and the homology of the genes was analyzed with the use of PFGE.RESULTS The result of the drug susceptibility testing indicated that all of the strains were multidrug-resistant,the drug resistance rates to piperacillin,piperacillin-tazobactam,ceftazidime and cefepime were more than 90%;the drug susceptibility rate to amikacin was the highest(62.4%),followed by cefoperazonesulbactam and levofloxacin.The PCR result showed that all of the 60 strains of A.baumannii were detected to carry with OXA-23 and OXA-51 genotypes;the PFGE result showed that all of the strains carry with the same genotype.CONCLUSION OXA-23 and OXA-51 genotypes are detected in the carbapenem-resistant A.baumannii strains isolated from the ICUs of the Centre Hospital Shaoxing City Zhejiang Province and are the homological genotype,which is considered to be induced by nosocomial infection,therefore,it is necessary to take effective measures to control the spread of the strains.
OBJECTIVE To investigate the drug resistance and genotypes of carbapenem-resistant Acinetobacter baumannii strains isolated from the patients who were hospitalized in the ICUs of the Centre Hospital Shaoxing City Zhejiang Province.METHODS A total of 60 strains of carbapenem-resistant A.baumannii were isolated from the patients who were hospitalized in the ICUs of the Centre Hospital Shaoxing City Zhejiang Province,the routine drug susceptibility testing was performed by using microdilution method,the drug resistance genes that were carried by strains were detected by means of multiple PCR technique,and the homology of the genes was analyzed with the use of PFGE.RESULTS The result of the drug susceptibility testing indicated that all of the strains were multidrug-resistant,the drug resistance rates to piperacillin,piperacillin-tazobactam,ceftazidime and cefepime were more than 90%;the drug susceptibility rate to amikacin was the highest(62.4%),followed by cefoperazonesulbactam and levofloxacin.The PCR result showed that all of the 60 strains of A.baumannii were detected to carry with OXA-23 and OXA-51 genotypes;the PFGE result showed that all of the strains carry with the same genotype.CONCLUSION OXA-23 and OXA-51 genotypes are detected in the carbapenem-resistant A.baumannii strains isolated from the ICUs of the Centre Hospital Shaoxing City Zhejiang Province and are the homological genotype,which is considered to be induced by nosocomial infection,therefore,it is necessary to take effective measures to control the spread of the strains.
引文
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[12] Jiang F,Deng LH,Kang HQ,et al.Application evaluation of three kinds of genotyping methods in Acinetobacter baumannii[J].Int J Lab Med,2015,36(9):1195-1197.
[13] Yang H,Huang L,Barmie PA,et al.Characterization and distribution of drug resistance associated b-lacatmase,membrane porin and efflux pump genes in MDR A.baumannii isolated from Zhenjiang,China[J].Int J Clin Exp Med,2015,8(9):15393-15402.
[14] Tomaschek F,Higgins PG,Stefanik D,et al.Head-to-head comparison of two multi-locus sequence typing(MLST)schemes for characterization of Acinetobacter baumannii outbreak and sporadic isolates[J].PLoS One,2016,11(4):e0153014.
[15]张小红,徐英春,原英,等.替加环素等14种抗菌药物对多重耐药菌的体外抗菌活性研究[J].中国感染与化疗杂志,2009,9(5):365-368.
[16] Yoon EJ,Kim JO,Yang JW,et al.The blaOXA-23-associated transposons in the genome of Acinetobacter spp.represent an epidemiological situation of the species encountering carbapenems[J].Antimicrob Chemother,2017,72(10):2708-2714.
[17] Kanamori H,Parobek CM,Weber DJ,et al.Next-generation sequencing and comparative analysis of sequential outbreaks caused by multidrug-resistant Acinetobacter baumannii at a large academic burn center[J].Antimicrob Agents Chemother,2015,60(3):1249-1257.
[18] Yamamoto M,Nagao M,Matsumura Y,et al.Regional dissemination of Acinetobacter species harbouring metallo-β-lactamase genes in Japan[J].Clin Microbiol Infect,2013,19(8):729-736.
[19]周华,杜小幸,杨青,等.亚胺培南耐药鲍曼不动杆菌碳青霉烯酶和16SrRNA甲基化酶研究[J].中华流行病学杂志,2009,30(3):269-272.
[2] Fitzpatrick MA,Ozer EA,Hauser AR.Utility of whole-genome sequencing in characterizing Acinetobacter epidemiology and analyzing hospital outbreaks[J].Clin Microbiol,2016,54(3):593-612.
[3] Hammerum AM,Hansen F,Skov MN,et al.Investigation of apossible outbreak of carbapenem-resistant Acinetobacter baumannii in Odense,Denmark using PFGE,MLST and whole-genome-based SNPs[J].J Antimicrob Chemother,2015,70(7):1965-1968.
[4] Poirel L,Walsh TR,Cuvillier V,et al.Multiplex PCR for detection of acquired carbapenemase genes[J].Diagn Microbiol Infect Dis,2011,70:119-123.
[5] Woodford N,Ellington MJ,Coelho JM,et al.Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp[J].Int J Antimicrob Agents,2006,27(4):351-353.
[6] Cuzon G,Naas T,Truong H,et al.Worldwide diversity of Klebsiella pneumoniae that produce beta-lactamase blaKPC-2gene[J].Emerg Infect Dis,2010,16(9):1349-1356.
[7] Tenover FC,Arbeit RD,Goering RV,et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel P lectrophoresis:criteria for bacterial strain typing[J].J Clin Microbiol,1995,33:12233-12239.
[8] Pagano M,Martins AF,Barth AL.Mobile genetic elements related to carbapenem-resistance in Acinetobacter baumannii[J].Braz J Microbiol,2016,47(4):785-792.
[9] 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.
[10]周云题,姜飞,陆召军,等.医院内感染碳青霉烯类耐药鲍曼不动杆菌的耐药基因及同源性分析[J].国际检验医学杂志,2016,37(8):2105-2107.
[11] Gong Y,Shen X,Huang G,et al.Epidemiology and resistance features of Acinetobacter baumannii isolates from the ward environment and patients in the burn ICU of a Chinese hospital[J].J Microbiol,2016,54(8):551-558.
[12] Jiang F,Deng LH,Kang HQ,et al.Application evaluation of three kinds of genotyping methods in Acinetobacter baumannii[J].Int J Lab Med,2015,36(9):1195-1197.
[13] Yang H,Huang L,Barmie PA,et al.Characterization and distribution of drug resistance associated b-lacatmase,membrane porin and efflux pump genes in MDR A.baumannii isolated from Zhenjiang,China[J].Int J Clin Exp Med,2015,8(9):15393-15402.
[14] Tomaschek F,Higgins PG,Stefanik D,et al.Head-to-head comparison of two multi-locus sequence typing(MLST)schemes for characterization of Acinetobacter baumannii outbreak and sporadic isolates[J].PLoS One,2016,11(4):e0153014.
[15]张小红,徐英春,原英,等.替加环素等14种抗菌药物对多重耐药菌的体外抗菌活性研究[J].中国感染与化疗杂志,2009,9(5):365-368.
[16] Yoon EJ,Kim JO,Yang JW,et al.The blaOXA-23-associated transposons in the genome of Acinetobacter spp.represent an epidemiological situation of the species encountering carbapenems[J].Antimicrob Chemother,2017,72(10):2708-2714.
[17] Kanamori H,Parobek CM,Weber DJ,et al.Next-generation sequencing and comparative analysis of sequential outbreaks caused by multidrug-resistant Acinetobacter baumannii at a large academic burn center[J].Antimicrob Agents Chemother,2015,60(3):1249-1257.
[18] Yamamoto M,Nagao M,Matsumura Y,et al.Regional dissemination of Acinetobacter species harbouring metallo-β-lactamase genes in Japan[J].Clin Microbiol Infect,2013,19(8):729-736.
[19]周华,杜小幸,杨青,等.亚胺培南耐药鲍曼不动杆菌碳青霉烯酶和16SrRNA甲基化酶研究[J].中华流行病学杂志,2009,30(3):269-272.