摘要
目的研究医院鲍氏不动杆菌（ABA）耐药性与分布及产碳青霉烯酶的基因型、分子流行特征,为ABA的医院感染预防控制提供依据。方法收集医院2007-2009年分离自患者痰液以外不同部位ABA,统计其在各年及临床科室的分布,采用纸片扩散法确定其耐药率,应用WHONET 5.4统计软件进行分析;选取194株多药耐药株,应用多重PCR检测碳青霉烯酶、整合酶基因,选取3年blaOXA-23-like阳性不同耐药克隆菌各1株进行序列测定;脉冲场凝胶电泳（PFGE）分析菌株同源关系。结果 3年共收集ABA510株,其中多药耐药菌427株,占83.7%,所有菌株除对头孢哌酮/舒巴坦、米诺环素耐药率较低外,对其他11种抗菌药物耐药率在68.6%~84.9%;194株多药耐药菌携带有blaOXA-51-like基因,187株菌携带Ⅰ类整合子;164株菌携带blaOXA-23-like基因;1株菌检出blaOXA-58-like基因;PFGE图谱显示,A型和B型为主要流行型别,分别为79株和58株,3年A型均有检出,而B型和H型在2008年增加明显,且2009年B型检出占到第1位。结论鲍氏不动杆菌检出有逐年上升趋势且耐药情况严重,多药耐药株常携带有OXA-23型碳青霉烯酶,科室内与不同科室间存在同型别流行,应引起重视。
OBJECTIVE To investigate antibiotic resistance and distribution of Acinetobacter baumannii isolates.Carbapenemase genotypes and molecular epidemiological characteristics of a proportion of multi-drug resistant ABA（MDRAB） were determined so as to provide evidences for nosocomial infection control strategy.METHODS ABA strains collected from different body sites（sputum were excluded） between the year 2007 and 2009 were collected,the year distribution,clinical department distribution and antibiotic resistance rate determined by K-B method were analyzed by WHONET-5.4 software.Genes of carbapenemase were amplified by multiplex PCR and its products were sequenced.Epidemiological genotypes of the resistant isolates selected was analyzed by pulse-field gel electrophoresis（PFGE）.RESULTS Totally 427ABA strains among the 510 strains were identified as MDR ABA,all the ABA strains maintained fairly high resistant rate（68.8%~84.9%） to 13 kinds of antibiotics except cefoperazone/sulbactam and Minocycline with resistant rates of 24.7% and 34.4%,respectively.Gene detection showed that among the 194 selected MDR ABA strains,100.0% carried blaOXA-51-like gene,96.4%（187）carried Class 1 integron,84.5%（164）strains carried blaOXA-23 gene and 1strain possessed blaOXA-58-like gene.PFGE showed that 194 strains tested were divided into 16 different genotypes,type A and type B played dominant role in epidemiology,type A existed in three years,whereas,type B and type H increased significantly,and type B was the most common genotype in 2009.CONCLUSION The number of ABA strains isolated from our hospital increases rapidly and exhibits high antibiotic resistant rate.Most MDRAB strains carry blaOXA-23 type carbapenemase,and different clones can be found among clinical departments,therefore,the great emphasis should be put.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2011年第8期1501-1503,共3页
Chinese Journal of Nosocomiology
基金
全军"十一五"基金课题(4241217M)
关键词
鲍氏不动杆菌
碳青霉烯酶
多药耐药
医院感染
Acinetobacter baumannii
Carbapenemase
Multidrug-resistance
Nosocomial infections
