| 周 玉,龚美亮,闫中强,丛玉隆,邓新立.分离自老年病房的鲍曼不动杆菌耐药机制初步研究*[J].,2019,19(1):99-103 |
| 分离自老年病房的鲍曼不动杆菌耐药机制初步研究* |
| The Preliminary Research on Resistance Mechanism of Acinetobacter baumannii Prevalent in Geriatric Wards* |
| 投稿时间：2018-03-08 修订日期：2018-03-28 |
| DOI：10.13241/j.cnki.pmb.2019.01.021 |
| 中文关键词: 鲍曼不动杆菌 老年患者 耐药基因 |
| 英文关键词: Acinetobacter baumannii Senile Patients Resistance gene |
| 基金项目:全军医学科技“十二五”科研项目重点课题（BWS11-C073） |
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| 中文摘要: |
| 摘要 目的：检测老年住院患者分离的鲍曼不动杆菌的主要耐药基因，并研究不同耐药基因型与耐药表型之间的对应关系。方法：用PCR方法检测分离自老年住院患者的不同标本来源的170例非重复鲍曼不动杆菌的耐药基因。检测的耐药基因包括D类碳青霉烯酶：blaOXA-51，blaOXA-23，blaOXA-24，blaOXA-58，B类金属碳青霉烯酶：blaVIM，blaIMP，blaSIM，blaGIM，blaDIM，blaNDM-1，以及A类超广谱β-内酰胺酶：blaKPC，共计11种。根据检测结果对菌株进行基因分型，并研究不同基因型与CRAB和CSAB这两种耐药表型之间的对应关系。结果：170株鲍曼不动杆菌的固有基因blaOXA-51均为阳性，此外，主要检出基因为blaOXA-23，共124株。另外检测出blaKPC 12株，blaOXA-58 6株，blaNDM-13株，blaSIM 2株，blaOXA-24、blaVIM和blaDIM各1株，IMP和GIM未检出。根据检出耐药基因的不同组合，分为blaOXA-51 + blaOXA-23阳性为基础的A型（124株）及blaOXA-23阴性为基础的B型（blaOXA-51，39株）、C型（blaOXA-51 + blaOXA-58，6株）、D型（blaOXA-51 + blaOXA-24，1株）共计四类基因型。从耐药表型来看，128株碳青霉烯耐药菌中有122株blaOXA-23为阳性， 在CRAB中占95.3%（122/128），42株碳青霉烯敏感株中，有40株blaOXA-23为阴性，在CSAB中占95.2%（40/42）。结论：老年病房流行的耐碳青霉烯鲍曼不动杆菌的耐药基因型以blaOXA-23阳性为主。其与鲍曼不动杆菌CRAB耐药表型、blaOXA-23阴性与CSAB耐药表型之间有良好的对应关系。 |
| 英文摘要: |
| ABSTRACT Objective: To detect the major resistance genes of A. baumannii isolated from elderly hospitalized inpatients, and to research the relationship between the resistance genotype and the drug resistant phenotype. Methods: PCR was used to detect the resistance genes of 170 non repetitive AB isolated from different specimens of elderly inpatients, and the resistant genes included the class D carbapenem enzyme: blaOXA-51, blaOXA-23, blaOXA-24, blaOXA-58, class B carbapenem enzyme: blaVIM, blaIMP, blaSIM, blaGIM, blaDIM, blaNDM-1, and type A extended spectrum beta lactamases: blaKPC. Genotyping was applied according to the test results, and the corresponding relationships between different genotypes and phenotypes (including CRAB and CSAB)were investigated. Results: blaOXA-51 was detected in all 170 isolates and blaOXA-23 was detected in 124 isolates. The other test results were as follows: blaKPC (12 strains), blaOXA-58 (6 strains), blaNDM-1 (3 strains), blaSIM (2 strains), blaOXA-24 (1 strains), blaVIM(1 strains) and blaDIM (1 strains), and blaIMP and blaGIM genes were not detected any more. According to the different combination of drug resistance genes, 170 strains were divided into four genotypes: type A was based on blaOXA-51 + blaOXA-23 (124 strains), and others were based on negative of blaOXA-23: type B (blaOXA-51, 39 strains), type C (blaOXA-51 + blaOXA-58, 6 strains), type D (blaOXA-51 + blaOXA-24, 1 strain). In the resistant phenotype, 122 of the 128 carbapenems resistant strains were positive for blaOXA-23, blaOXA-23 positive strains in CRAB accounted for 95.3% (122/128), 40 of 42 carbapenems susceptible strains were negative for blaOXA-23, blaOXA-23 negative strains in CSAB accounted for 95.2% (40/42). Conclusion: The resistant genotypes of carbapenem resistant AB prevalent in geriatric wards were mainly blaOXA-23 positive. There was a good correspondence between blaOXA-23 positive and CRAB phenotype, and correspondingly between blaOXA-23 negative and CSAB phenotype. |
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