鲍曼不动杆菌耐药性分析及AmpC β-内酰胺酶基因研究
| 作者: |
1李艳明,
2刘一凡,
1简子娟,
1刘文恩,
1李艳华,
3谷秀梅,
1彭婉婵
1 中南大学 湘雅医院检验科，长沙 410008 2 中南大学 湘雅医学院检验系，长沙 410013 3 中南大学 湘雅医院检验科，长沙 410008 |
| 通讯: |
刘文恩
Email: liuwenen@gmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2014.01.006 |
摘要
目的：了解临床标本分离的鲍曼不动杆菌(Acinetobacter baumannii，Ab)对常见抗生素的耐药现状并研究Ab中质粒及染色体介导的AmpC β-内酰胺酶基因的分布特点。方法：应用VITEK-2微生物分析系统对中南大学湘雅医院2010年11月至2011年4月临床标本进行分离培养、鉴定和药物敏感性分析，采用PCR扩增方法对173株非重复Ab blaMOX，blaCMY-2，blaDHA，blaACC，blaACT-1，blaFOX，blaADC六种耐药基因进行分析。结果：173株临床分离菌株对第一、三代头孢菌素，青霉素，磺胺类复合制剂及呋喃妥因的耐药率均超过70%；对喹诺酮类药物中左旋氧氟沙星、环丙沙星耐药率分别为23.7%和89.0%；对氨基糖苷类抗生素耐药率为58.4%~85.5%；对氨曲南的耐药率为51.4%；对碳青霉烯类、第四代头孢菌素及β-内酰胺/β-内酰胺酶抑制剂复合物耐药率为8.7%~89.6%(其中耐药率最低的为头孢哌酮/舒巴坦)。173株Ab中携带blaADC基因的为154株(89.0%)，且产blaADC基因的菌株对头孢曲松、庆大霉素、妥布霉素、复方新诺明、环丙沙星、亚胺培南的耐药率高于不产blaADC基因的菌株，两组间差异具有统计学意义(P<0.05)。未扩增出blaMOX，blaCMY-2，blaDHA，blaACC，blaACT-1，blaFOX五种耐药基因。结论：头孢哌酮/舒巴坦可作为治疗Ab感染的推荐药物。产ADC型AmpC β-内酰胺酶是Ab菌株对头孢曲松、庆大霉素、妥布霉素、复方新诺明、环丙沙星、亚胺培南耐药的重要原因之一。
关键词：
鲍曼不动杆菌；AmpC酶；耐药基因
Study on drug resistance and genes of AmpC β-lactamases in Acinetobacter baumannii
CorrespondingAuthor: LIU Wenen Email: liuwenen@gmail.com
DOI: 10.3978/j.issn.2095-6959.2014.01.006
Abstract
Objective: To investigate the distribution and drug resistance of Acinetobacter baumannii from Xiangya Hospital and to explore the genes of AmpC β-lactamases in Acinetobacter baumannii. Methods: Acinetobacter baumannii were isolated from November 2010 to April 2011 from Xiangya Hosipital, Central South University. All strains were identified and determined the MICs of the common antibiotics by VITEK-2 System. The resisitance genes, blaMOX, blaCMY-2, blaDHA, blaACC, blaACT-1, blaFOX, blaADC were analyzed by PCR. Results: Total isolated strains were highly resistant to the first and third-generations of cephalosporin and penicillin, sulfamethoxazole, nitrofuranton (>70%). The resistance rate to quinolones, aminoglycosides, aztreonam, carbapenems/forth generations of cephalosporin/β-lactam/β-lactamase inhibitor-resistant complex was 23.7%-89.0%, 58.4%-85.5%, 51.4%, and 8.7%-89.6%, respectively. The resistance rate to cefoperazone/sulbactam was the lowest. The rate of carrying blaADC was 89.0%, and the resistance rates of blaADC-positive strains to ceftriaxone, gentamicin, tobramycin, sulfamethoxazole, ciprofloxacin, imipenem was significantly higher than that of blaADC-negative strains (P<0.05). The gene of blaMOX, blaCMY-2, blaDHA, blaACC, blaACT-1, blaFOX were not detected. Conclusion: Cefoperazone/sulbactam is recommended as treatment drugs of Acinetobacter baumannii infection. ADC type AmpC β-lactamase might be an important factor of drug resistance to ceftriaxone, gentamicin, tobramycin, sulfamethoxazole, ciprofloxacin, imipenem in Acinetobacter baumannii.