临床分离鲍曼不动杆菌耐药分布及其碳青霉烯类耐药基因研究
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摘要
目的:研究住院患者感染鲍曼不动杆菌耐药分布及碳青霉烯类耐药基因,为临床预防和治疗感染提供实验指导。方法:收集2018年1至12月芜湖市中医医院住院患者痰液标本,培养分离鲍曼不动杆菌,采用最小抑菌浓度(MIC)法检测耐药结果,PCR法扩增检测耐药基因。结果:临床分离鲍曼不动杆菌共68株,重症医学科检出率最高。68株鲍曼不动杆菌对常见药物氨曲南、头孢曲松、头孢他啶、头孢吡肟、左氧氟沙星、头孢替坦、氨苄西林、氨苄西林/舒巴坦、亚胺培南耐药率分别为95.59%、48.53%、48.53%、48.53%、25.00%、95.59%、100%、48.53%、48.53%。33株耐碳青霉烯类鲍曼不动杆菌OXA-23、OXA-24、OXA-51、OXA-58等耐药基因阳性菌株分别为25株、0株、33株、0株,阳性率分别为75.8%、0%、100%、0%。耐药基因OXA-23在耐碳青霉烯类组和敏感组鲍曼不动杆菌比较中差异有统计学意义(P<0.01)。结论:2018年我院住院患者感染鲍曼不动杆菌对抗菌药物耐药广泛,碳青霉烯类耐药基因检测对预防菌株耐药发展具有指导意义。
Objective: To investigate the drug resistant distribution and carbapenem-resistant genes of Acinetobacter baumannii in inpatients, in order to provide the guide to clinical prevention and treatment. Methods: Sputum samples were collected from inpatients in our hospital from Jan 2018 to Dec 2018. Drug resistance was measured by MIC method, carbapenem-resistant genes were detected by PCR. Results: A total of 68 strains of Acinetobacter baumannii isolated from clinical department, the highest detection rate was found in intensive care unit. The resistance of 68 strains to aztreonam, ceftriaxone, ceftazidime, cefepime,levofloxacin, cefotetan, ampicillin, ampicillin/sulbactam, imipenem were 95.59%, 48.53%, 48.53%, 48.53%, 25.00%, 95.59%, 100%,48.53%, 48.53%,respectively. The OXA-23 gene was detected in 25 of 33 carbapenem-resistant strains(75.8%), the OXA-24 gene was detected in 0 of 33 carbapenem-resistant strains(0%), the OXA-51 gene was detected in 33 of 33 carbapenem-resistant strains(100%), the OXA-58 gene was detected in 0 of 33 carbapenem-resistant strains(0%). The difference of OXA-23 gene distribution in CRAB and CSAB was statistically significant(P<0.01). Conclusion: Acinetobacter baumannii infecting inpatients is multi-drug resistance, monitoring carbapenem-resistant genes is critical to preventing and developing of drug resistance.
Objective: To investigate the drug resistant distribution and carbapenem-resistant genes of Acinetobacter baumannii in inpatients, in order to provide the guide to clinical prevention and treatment. Methods: Sputum samples were collected from inpatients in our hospital from Jan 2018 to Dec 2018. Drug resistance was measured by MIC method, carbapenem-resistant genes were detected by PCR. Results: A total of 68 strains of Acinetobacter baumannii isolated from clinical department, the highest detection rate was found in intensive care unit. The resistance of 68 strains to aztreonam, ceftriaxone, ceftazidime, cefepime,levofloxacin, cefotetan, ampicillin, ampicillin/sulbactam, imipenem were 95.59%, 48.53%, 48.53%, 48.53%, 25.00%, 95.59%, 100%,48.53%, 48.53%,respectively. The OXA-23 gene was detected in 25 of 33 carbapenem-resistant strains(75.8%), the OXA-24 gene was detected in 0 of 33 carbapenem-resistant strains(0%), the OXA-51 gene was detected in 33 of 33 carbapenem-resistant strains(100%), the OXA-58 gene was detected in 0 of 33 carbapenem-resistant strains(0%). The difference of OXA-23 gene distribution in CRAB and CSAB was statistically significant(P<0.01). Conclusion: Acinetobacter baumannii infecting inpatients is multi-drug resistance, monitoring carbapenem-resistant genes is critical to preventing and developing of drug resistance.
引文
[1]孙立颖,黄磊,徐国宾.碳青霉烯类耐药鲍曼不动杆菌耐药特征及分子流行病学研究[J].临床检验杂志,2012,30(7):553-556.
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[5]魏常梅,王俊瑞,孙鹏,等.鲍曼不动杆菌外膜蛋白W的克隆表达及纯化[J].中国病原生物学杂志,2016,11(2):139-143.
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[8]李春红,周英顺,曾静,等.87株鲍曼不动杆菌ESBLs、OXA基因的PCR扩增及序列分析[J].基因组学与应用生物学,2018,37(6):2697-2701.
[9]邓德耀,袁文丽,刘春林.OXA-51型β内酰胺酶的研究进展[J].中国感染与化疗杂志,2014,14(5):451-454.
[10]Ning NZ,Liu X,Bao CM,et al.Molecular epidemiology of blaOXA-23-producing carbapenem-resistant Acinetobacter baumannii in a single institution over a 65-month period in north China[J].BMC Infect Dis,2017,17(1):14.
[11]Che T,Bonomo RA,Shanmugam S,et al.Carboxylation and decarboxylation of active site Lys 84 controls the activity of OXA-24β-lactamase of Acinetobacter baumannii:Raman crystallographic and solution evidence[J].J Am Chem Soc,2012,134(27):11206-11215.
[12]Liao YT,Kuo SC,Chiang MH,et al.Acinetobacter baumannii extracellular OXA-58 is primarily and selectively released via outer membrane vesicles after sec-dependent periplasmic translocation[J].Antimicrob Agents Chemother,2015,59(12):7346-7354.
[13]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.
[14]刘振茹,凌保东.鲍曼不动杆菌16S rRNA甲基化酶与氨基糖苷修饰酶基因检测研究[J].中国抗生素杂志,2012,37(5):338-342.
[15]蒋佩军,许小敏,冯伟云,等.耐药鲍曼不动杆菌氟喹诺酮类耐药基因研究[J].现代实用医学,2014,26(6):756-757.
[16]闻海丰,秦瑾.替加环素等常用抗生素对鲍曼不动杆菌体外药敏结果分析[J].中国抗生素杂志,2015,40(7):538-542.
[17]Peleg AY,Potoski BA,Rea R,et al.Acinetobacter baumannii bloodstream infection while receiving tigecycline:a cautionary report[J].J Antimicrob Chemother,2007,59(1):128-131.
[18]Khorsi K,Messai Y,Hamidi M,et al.High prevalence of multi-drug-resistance in Acinetobacter baumannii and dissemination of carbapenemase-encoding genes blaOXA-23-like,blaOXA-24-like and blaNDM-1 in Algiers hospital[J].Asian Pac J Trop Med,2015,8(6):439-446.
[19]宋志方,俞国峰,孙雪东,等.重症医学科耐碳青霉烯鲍曼不动杆菌耐药基因研究[J].中国卫生检验杂志,2018,28(20):2461-2462,2465.
[20]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[21]Tran TB,Cheah SE,Yu HH,et al.Anthelmintic closantel enhances bacterial killing of polymyxin B against multidrug-resistant Acinetobacter baumannii[J].J Antibiot(Tokyo),2015,69(6):415-421.2019-02-01
[2]张丽红,陈贤君.重症监护病房多重耐药菌感染及耐药性变化趋势[J].中国消毒学杂志,2015,32(12):1209-1212.
[3]Longo B,Pantosti A,Luzzi I,et al.Molecular findings and antibiotic-resistance in an outbreak of Acinetobacter baumannii in an intensive care unit[J].Ann Ist Super Sanita,2007,43(1):83-88.
[4]Li YJ,Pan CZ,Fang CQ,et al.Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients:genetic relationships,risk factors and mortality[J].BMCInfect Dis,2017,17(1):371.
[5]魏常梅,王俊瑞,孙鹏,等.鲍曼不动杆菌外膜蛋白W的克隆表达及纯化[J].中国病原生物学杂志,2016,11(2):139-143.
[6]全国细菌耐药监测网(CARSS).2017年全国细菌耐药监测报告(简要版)[EB/OL].(2018-11-30)[2019-04-22]http://www.carss.cn/.
[7]曾令怡,赵永鑫,郭宇航,等.耐碳青霉烯鲍曼不动杆菌插入序列及其水平传播[J].中国微生态学杂志,2018,30(9):1047-1051.
[8]李春红,周英顺,曾静,等.87株鲍曼不动杆菌ESBLs、OXA基因的PCR扩增及序列分析[J].基因组学与应用生物学,2018,37(6):2697-2701.
[9]邓德耀,袁文丽,刘春林.OXA-51型β内酰胺酶的研究进展[J].中国感染与化疗杂志,2014,14(5):451-454.
[10]Ning NZ,Liu X,Bao CM,et al.Molecular epidemiology of blaOXA-23-producing carbapenem-resistant Acinetobacter baumannii in a single institution over a 65-month period in north China[J].BMC Infect Dis,2017,17(1):14.
[11]Che T,Bonomo RA,Shanmugam S,et al.Carboxylation and decarboxylation of active site Lys 84 controls the activity of OXA-24β-lactamase of Acinetobacter baumannii:Raman crystallographic and solution evidence[J].J Am Chem Soc,2012,134(27):11206-11215.
[12]Liao YT,Kuo SC,Chiang MH,et al.Acinetobacter baumannii extracellular OXA-58 is primarily and selectively released via outer membrane vesicles after sec-dependent periplasmic translocation[J].Antimicrob Agents Chemother,2015,59(12):7346-7354.
[13]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.
[14]刘振茹,凌保东.鲍曼不动杆菌16S rRNA甲基化酶与氨基糖苷修饰酶基因检测研究[J].中国抗生素杂志,2012,37(5):338-342.
[15]蒋佩军,许小敏,冯伟云,等.耐药鲍曼不动杆菌氟喹诺酮类耐药基因研究[J].现代实用医学,2014,26(6):756-757.
[16]闻海丰,秦瑾.替加环素等常用抗生素对鲍曼不动杆菌体外药敏结果分析[J].中国抗生素杂志,2015,40(7):538-542.
[17]Peleg AY,Potoski BA,Rea R,et al.Acinetobacter baumannii bloodstream infection while receiving tigecycline:a cautionary report[J].J Antimicrob Chemother,2007,59(1):128-131.
[18]Khorsi K,Messai Y,Hamidi M,et al.High prevalence of multi-drug-resistance in Acinetobacter baumannii and dissemination of carbapenemase-encoding genes blaOXA-23-like,blaOXA-24-like and blaNDM-1 in Algiers hospital[J].Asian Pac J Trop Med,2015,8(6):439-446.
[19]宋志方,俞国峰,孙雪东,等.重症医学科耐碳青霉烯鲍曼不动杆菌耐药基因研究[J].中国卫生检验杂志,2018,28(20):2461-2462,2465.
[20]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[21]Tran TB,Cheah SE,Yu HH,et al.Anthelmintic closantel enhances bacterial killing of polymyxin B against multidrug-resistant Acinetobacter baumannii[J].J Antibiot(Tokyo),2015,69(6):415-421.2019-02-01