摘要
目的:为临床合理用药与医院感染控制提供参考。方法:收集我院2014年1月-2017年6月检出的鲍曼不动杆菌(AB),采用纸片扩散法和最低抑菌浓度法进行药敏试验。采用聚合酶链反应法对多重耐药鲍曼不动杆菌(MDR-AB)耐药基因进行扩增,并与Gen Bank数据库进行Blast比对。结果:共检出AB 1 758株,主要来自于痰液及咽拭子标本(65.24%),其次为尿液标本(18.49%);主要分布于重症医学科(ICU)(38.51%)和呼吸内科(24.00%)。AB对复方磺胺甲噁唑、哌拉西林钠他唑巴坦钠、庆大霉素、头孢吡肟、左氧氟沙星、米诺环素、亚胺培南等大部分常用抗菌药物的耐药率均超过了40%,且有逐年上升的趋势;对黏菌素的耐药率<5%,且逐年下降。共检出MDR-AB 673株,各年度检出率依次为22.77%、29.82%、52.09%、54.33%。110株检测耐药基因的MDR-AB菌株中,TEM、Amp C、IMP、VIM、OXA-23、OXA-24、OXA-51、aac(6′)-Ⅰ、aac(3)-Ⅰ、ant(3″)-Ⅰ、anmA、gyrA、parC基因的检出率分别为97.27%、91.82%、49.09%、12.73%、90.91%、12.73%、98.18%、34.55%、60.91%、89.09%、87.27%、77.27%、82.73%。Blast比对结果显示,gyr A基因第83、121位碱基发生点突变,parC基因第144位碱基发生点突变。结论:我院AB主要来自于痰液及咽拭子标本,主要集中在ICU和呼吸内科;耐药情况严重,MDR-AB的检出率逐年升高。多重耐药菌株检出的主要基因包括TEM、AmpC、OXA-23、OXA-51、ant(3″)-Ⅰ、anmA等,且gyrA、parC基因存在突变。临床应加大抗菌药物分级使用管理力度,加强AB耐药性监测,并根据药敏试验结果合理选择抗菌药物,防止或延缓AB耐药菌株在医院内定植与交叉传播。
OBJECTIVE：To provide reference for rational drug use in clinic and nosocomial infection control. METHODS：Acinetobacter baumannii（AB）were collected from our hospital during Jan. 2014-Jun. 2017. Drug sensitivity tests were conducted by using K-B method and MIC method. Drug-resistance genes of multidrug-resistant Acinetobacter baumannii（MDR-AB）were amplified by PCR,and compared with Gen Bank database by using Blast comparison. RESULTS：A total of 1 758 strains of AB were detected,and mainly came from sputum and throat swab（65.24%）,followed by urine（18.49%）. These infected patients were mainly distributed in the departments of ICU（38.51%）and respiratory medicine（24.00%）,respectively. Drug resistance of clinical isolated AB to most commonly used antibiotics were more than 40%,such as compound sulfamethoxazole,piperacillin sodium and tazobactam sodium,gentamicin,cefepime,levofloxacin,minocycline,imipenem,etc.;it had increased year after year. Drug resistance to colistin was lower than 5% and decreased year by year. A total of 673 strains of MDR-AB were detected,and detection rates were 22.77%,29.82%,52.09%,54.33%,respectively. Among 110 strains of MDR-AB,detection rates of TEM,AmpC,IMP,VIM,OXA-23,OXA-24,OXA-51,aac（6′）-Ⅰ,aac（3）-Ⅰ,ant（3″）-Ⅰ,anmA,gyrA,parC gene were 97.27%,91.82%,49.09%,12.73%、90.91%,12.73%,98.18%,34.55%,60.91%,89.09%,87.27%,77.27%,82.73%,respectively.Results of Blast comparison showed that point mutation occurred in 83rd and 121st base of gyr A gene,144th base of par C gene. CONCLUSIONS：AB mainly come from sputum and throat swab specimens in our hospital,and infected patients are mainly distributed in the departments of ICU and respiratory medicine. Drug resistance is serious,and the detection rate of MDR-AB is increased year by year. Main genes of multidrug-resistant strains mainly include TEM,AmpC,OXA-23,OXA-51,ant（3″）-Ⅰ,anm A,etc.,and mutation of gyrA and parC gene are found. It is necessary to strengthen the management of classification use of antibiotics and strengthen the monitoring of AB drug resistance. According to the results of drug sensitivity test,antibiotics are selected rationally to prevent or delay planting and cross transmission of AB-resistant strain.
作者
张宇琼
高晶晶
陆文香
张宇蔺
袁垆
徐卫东
ZHANG Yuqiong, GAO Jingjing, LU Wenxiang, ZHANG Yulin, YUAN Lu, XU Weidong(Dept. of Clinical Laboratory, Suzhou Municipal Hospital, Jiangsu Suzhou 215002, Chin)
出处
《中国药房》
CAS
北大核心
2018年第6期794-799,共6页
China Pharmacy
基金
苏州市"科教兴卫"青年科技项目(No.KJXW-2016025)
关键词
鲍曼不动杆菌
多重耐药
耐药性
临床分布
耐药基因
Acinetobacter baumannii
Multidrug-resistance
Drug resistance
Clinical distribution
Drug-resistance gene
