鲍曼不动杆菌耐药性监测与碳青霉烯酶基因型研究

目的：对鲍曼不动杆菌耐药性及碳青霉烯酶基因型进行研究,以指导临床合理应用抗生素。方法：收集青岛市海慈医疗集团2009年6月至2010年6月从临床分离的鲍曼不动杆菌60株,用琼脂稀释法测定最低抑菌浓度（M IC）,改良Hodge试验检测碳青霉烯酶,用PCR法检测OXA-23,OXA-24,OXA-58基因,并对PCR产物进行测序。结果：①鲍曼不动杆菌检出率前两位是ICU病房和呼吸科病房,分别占32.3%和27.4%,多重耐药鲍曼不杆菌阳性率最高的是ICU,为70.6%（12/17）,其次为呼吸科病房,为35.0%（7/20）,哌拉西林、哌拉西林/他唑巴坦、头孢曲松、头孢他啶、头孢吡肟、亚胺培南、美罗培南、庆大霉索、阿米卡星、环丙沙星、左氧氟沙星、加替沙星、头孢哌酮/舒巴坦、氨曲南耐药率分别为92.3%、55.4%、88.6%、86.3%、80.3%、30.0%、35.0%、76.6%、79.6%、75.1%、87.1%、48.3%、42.0%和79.6%.②在21株耐碳青霉烯类鲍曼不动杆菌,有14株碳青霉烯酶表型阳性,检出率为66.7%,有18株PCR扩增出OXA-23基因,检出率85.7%,全部菌株blaOXA-24及blaOXA-58PCR扩增均为阴性,PCR产物测序表明与鲍曼不动杆菌（AY795964.1）blaOXA-23基因序列100%同源。结论：鲍曼不动杆菌多重耐药性严重;表型和基因型检测证实本院临床分离鲍曼不动杆菌对碳青霉烯类耐药机制主要是产OXA-23型酶。

Acinetobacter baumannii resistance monitoring and research of carbapenemase genotypes

Objective：To investigate antibiotic resistance and carbapenemases genotype in A cinetobacter baumannii,so as to guide the rational use of antibiotics in clinical.Methods：A total of 60 clinical isolates were collected from June 2009 to June 2010 in the Qingdao Hiser Medical Group.Agar dilution method was used to test minimum inhibitory concentrations（MICs）of 14 antibiotics,Hodge test was used to detect carbapenemases,PCR was used to detect OXA-23,OXA-24,OXA-58 genes,and the positive products of OXA genes were sequenced.Results：①The first and the second detection rate of A.baumannii is ICU ward and respiratory ward,which ac-counted for 32.3% and 27.4%,the highest positive rate of Multi-drug resistant A.baumannii is ICU,70.6%（12/17）,followed by respirato-ry ward,35.0%（7 / 20）.the resistance rates of 60 isolates to piperacillin,piperacillin / tazobactam,ceftriaxone,ceftazidime,cefepime,imipenem,meropenem,Gentamicin,amikacin,ciprofloxacin,levofloxacin,gatifloxacin cefoperazone / sulbactam and aztreonam,were 92.3%,55.4%,88.6%,86.3%,80.3%,30.0%,35.0%,76.6%,79.6%,75.1%,87.1% 48.3%,42.0% and 79.6% respectively.②In the 21 strains of carbapenem-resistant Acinetobacter baumannii,carbapenemase phenotypic testing results showed that the posive strains were 14,the detection rate of which was 66.7%.18 strains detected OXA-23 gene,the detection rate of which was 85.7%.All strains were not detected blaOXA-24 and blaOXA-58 genes.The sequenced results were absolutely homology with blaOXA-23 gene.Conclusion：The multi-drug resistance phenomenon of Ab are serious;Phenotype and genotype test confirmed the mainly mechanism of carbapenem-resis-tant Acinetobacter baumannii are producing OXA-23-type enzyme in our hospital.