2011～2015年鲍曼不动杆菌耐药相关基因及耐药性变迁研究

摘要

Objective To investigate the changes of drug resistance related genes and drug resistance of Acinetobacter Bau-mannii in hospital,and provide evidence for rational use of antibiotics in clinic.Methods A retrospective analysis of Shaanxi Corps Hospital of Chinese Peoples’s Armed Police Forces from 2011 to 2015 from clinical samples of 11 521 specimens were isolated and cultured 1 861 strains of Acinetobacter Baumannii,drug susceptibility test by K-B method.The antimicrobial minimum inhibitory concentration (MIC)according to the 2014 edition of the CLSI judgment criteria of judgment.Results 1 861 strains of Acinetobacter Baumannii were detected drug resistance genes gyrA,parC,OXA-51,OXA-23,int on the 1,I TEM,AAC (6’)-1,AAC (3’)-1,ant (3)-1,ant (2)-1 and Caro gene detection rates were 50.4%,72.1%,70.9%,55.7%, 56.2%,65.6%,12.9% and 89.9% respectively,and SHV,IMP and VIM genes were not detected.The sequencing results showed that gyrA and parC gene mutation was the main cause of quinolone resistance.The antibiotic resistance of Acineto-bacterBaumannii was an increasing trend year by year,and 1 861 strains has 1 419 strains showed multiple drug resistance, all strains were sensitive to polymyxin.In 2015,quinolones aminoglycosides resistance rate was more than 65%.To imipen-em,meropenem and Cefoperazone/sulbactam were 35.17%,36.01% and 42.40%.Conclusion The detection rate of Acine-tobacter Baumannii is increasing year by year,and the drug resistance and multi drug resistance is increasing year by year.It is necessary to strengthen the clinical rational drug use andcontrol the hospital infection.%目的：了解医院鲍曼不动杆菌耐药相关基因及耐药性变迁，为临床合理使用抗菌药物提供依据。方法回顾性分析武警陕西省总队医院2011～2015年从临床送检11521份标本中分离、培养出1861株鲍曼不动杆菌，药敏试验采用 K-B法，抗菌药物最低抑菌浓度（MIC）根据美国2014版CLSI判定标准进行判定。结果1861株鲍曼不动杆菌均能检测到耐药性基因 gyrA，parC，OXA-51，其中对 OXA-23，intⅠ1，TEM，aac（6’）-Ⅰ，aac（3’）-Ⅰ，ant（3”）-Ⅰ，ant（2”）-Ⅰ和 Caro基因的检出率分别为50.4％，72.1％，70.9％，55.7％，56.2％，65.6％，12.9％和89.9％，而 SHV，IMP，VIM等基因未检出。测序结果显示gyrA和parC基因有突变是导致喹诺酮类耐药的主要原因。鲍曼不动杆菌对常见抗生素耐药性是逐年递增趋势，且1861株鲍曼不动杆菌有1419株表现为多重耐药，所有菌均对多黏菌素敏感，2015年氨基糖苷类、喹诺酮类耐药率均为65％以上；对亚胺培南、美罗培南和头孢哌酮／舒巴坦耐药率分别为35.17％，36.01％和42.40％。结论鲍曼不动杆菌的检出率逐年上升，耐药性及多重耐药性也逐年增强，必须加强临床合理用药，控制医院感染。