多重耐药鲍曼不动杆菌的耐药性及其耐药基因分析

目的:探讨多重耐药鲍曼不动杆菌(MDR-Ab)的耐药性及其耐药基因,为临床合理选择抗菌药物提供依据。方法:回顾性分析2018年1月至2018年12月鲍曼不动杆菌感染的住院患者信息。使用VITEK-32微生物分析仪/梅里埃药敏卡片GN13鉴定MDR-Ab 95株。采用聚合酶链式反应(多重PCR)检测MDR-Ab携带相关耐药基因。结果:95株MDR-Ab对头孢类抗菌药物耐药率为100%。对氨苄西林-舒巴坦和头孢哌酮-舒巴坦耐药率分别为95.79%和81.05%,对美罗培南和亚胺培南耐药率分别为56.84%和57.89%,对庆大霉素和阿米卡星耐药率均为88.42%,对环丙沙星和左氧氟沙星耐药率分别为100%和88.42%,对四环素、米诺环素、替加环素耐药率分别为87.37%、16.84%和9.47%,对多粘菌素B耐药率为1.05%。95株MDR-Ab中携带β-内酰胺酶中A类酶耐药基因TEM、PER分别95株和25株,D类酶耐药基因OXA-51、carO和adeB各95株,OXA-23基因90株。携带消毒剂耐药基因qacE 60株。携带16S r RNA甲基化酶耐药基因armA 75株。每株MDR-Ab除携带TEM+carO+adeB+OXA-51四种基因外,另同时携带四种基因20株(21.05%),三种基因38株(40.00%)。结论:MDR-Ab对多种抗菌药物的耐药率较高,携带的耐药基因型主要为TEM、carO、adeB及OXA-51。携带多种耐药基因是MDR-Ab耐药重要原因。加强医院感染防控、合理应用抗菌药物对于延缓泛鲍曼不动杆菌耐药性发展具有重要的临床意义。

Analysis of Drug Resistance and Drug Resistance Gene of Multi-drug Resistant Acinetobacter Baumannii

ABSTRACT Objective: To analyse the drug resistance of Multi-drug Resistant Acinetobacter baumannii(MDR-Ab) and its drug resistance gene, in order to provide basis for clinical rational selection of antibiotics. Methods: Retrospective analysis of hospitalized patients with Acinetobacter baumannii infection from January 2018 to December 2018. MDR-Ab 95 strains were identified by VITEK-32 microbial analyzer/merrier drug sensitivity card GN13, and the MDR-Ab resistances genotypes of strains were analyzed by Polymerase chain reaction (PCR). Results: The resistance rate of 95 MDR-Ab strains to cephalosporins was 100%, the resistance rates to ampicillin- sulbactam and cefoperazone-sulbactam were 95.79% and 81.05%, the resistance rates to meropenem and imipenem were 56.84% and 57.89%, the drug resistance rate to gentamicin and amikacin was 88.42%, the resistance rates to ciprofloxacin and levofloxacin were 100% and 88.42%, the resistance rates to tetracycline, minocycline and tegacyclin were 87.37%, 16.84% and 9.47%, the resistance rate to polymyxin B was 1.05%. Among the 95 MDR-Ab strains, there were 95 strains of TEM and 25 strains of PER, 95 strains of OXA-51, 95 strains of carO and adeB, and 90 strains of OXA-23. There were 60 strains of qacE carrying disinfectant resistance gene. 75 strains of armA carrying 16S rRNA methylase resistance gene were identified. In addition to TEM+carO+adeB+OXA-51 genes, 20(21.05%) carry four genes and 38 (40.00%) strains carry three genes. Conclusion: MDR-Ab has a high resistance rate to a variety of antibiotics and TEM, carO, adeB and OXA-51 were the main resistant genotypes. Carrying multiple resistance gene is an important reason for MDR-Ab resistance. It''s important for delaying the development of drug resistance of Acinetobacter baumannii to rational application of antibiotics.