鲍曼不动杆菌的耐药情况及碳青霉烯酶基因检测

摘要

了解佳木斯大学附属第一医院鲍曼不动杆菌耐药性及碳青霉烯酶包括苯唑西林酶和金属酶相关耐药基因分布情况，为临床抗菌药物的合理选择提供依据。2013年9月至2014年12月使用VITEK－II全自动微生物鉴定／药敏测试系统筛选出佳木斯大学附属第一医院临床标本鲍曼不动杆菌69株；采用多重PCR方法检测鲍曼不动杆菌携带的碳青霉烯酶相关耐药基因16SrRNA、OXA－23、OXA－24、OXA－51、OXA－58、IMP、VIM、SIM，并对耐药基因扩增的阳性产物进行DNA序列分析。69株AB对亚胺培南、美洛培南的耐药率分别为36．2％、37．68％，对其他抗菌药物的耐药率均高于50％。6种耐药基因的检测结果为69株（100％）携带OXA－51基因，32株（46．4％）携带OXA－23基因，17株（24．6％）携带OXA－24基因，5株（7．2％）携带OXA－58基因，1株（1．4％）携带IMP基因。25株碳青霉烯类药物耐药鲍曼不动杆菌中，22株（88％）携带OXA－23，1株（4％）携带OXA－58，10株（40％）携带OXA－24，6株（24％）同时携带OXA－23、OXA－24。 DNA 序列分析结果显示：OXA－23、OXA－24、OXA－51、OXA－58分别与NCBI的序列同源性均为99％。产OXA－23型碳青霉烯酶可能是佳木斯大学附属第二医院鲍曼不动杆菌对碳青霉烯酶类抗菌药物耐药的主要原因，另外佳木斯大学附属第一医院存在OXA－24型耐药基因鲍曼不动杆菌的区域性流行。%In order to understand the distribution of Acinetobacter baumannii drug-resistance and carbapenemase in-cluding oxacillinase ( OXA) and metalloenzyme ( MLE) related resistance genes in the affiliated hospitals of Jiamusi University to provide a foundation for reasonable choice of clinical antibiotic medicine.69 A.baumannii strains were collected and screened in the hospital clinical samples identified by VITEK-II full-automatic microbial identification/susceptibility testing machine from September 2013 to December 2014.Multiplex PCR detection method was used to detect carbapenemase related resistant genes 16S rRNA, OXA-23, OXA-24, OXA-51, OXA-58, IMP, VIM and SIM.The positive amplified products were subjected to DNA sequence analysis.The results showed that the resistant rate of 69 strains to IMP and MEM were 36.2% and 37.68%.The resistant gene was obtained as follows: 69 (100%) carrying OXA-51 gene, 32 (46.4%) carrying OXA-23 gene, 17 (24.6%) carrying OXA-24 gene, 5 (6. 8%) carrying OXA-58 genes.Out of 25 carbapenem resistant strains of A.baumannii identified, 22 (88%) carried OXA-23, 1 (4%) carried OXA-58, 10 (40%) carried OXA-24, and 6 (24%) carried both OXA-23 and OXA-24. DNA sequence analysis of OXA-23, OXA-24, OXA-51 and OXA-58 with the NCBI sequence showed 99%homology. Therefore, the OXA-23 gene producer may be responsible for the main reason of A.baumannii carbapenemase antibi-otic resistance.Moreover, there exists regional epidemic of OXA-24 drug resistant gene A.baumannii in the hospital.