中华微生物学和免疫学杂志
中華微生物學和免疫學雜誌
중화미생물학화면역학잡지
CHINESE JOURNAL OF MICROBIOLOGY AND IMMUNOLOGY
2010年
9期
821-828
,共8页
王敏%王妹妹%姚迪%李先平%曹虹%秦章顺%杜世杰%曾海燕
王敏%王妹妹%姚迪%李先平%曹虹%秦章順%杜世傑%曾海燕
왕민%왕매매%요적%리선평%조홍%진장순%두세걸%증해연
鲍曼不动杆菌%多重耐药%表型%基因型%基因
鮑曼不動桿菌%多重耐藥%錶型%基因型%基因
포만불동간균%다중내약%표형%기인형%기인
Acinetobacter baumannii%Drug resistance,multiple%Phenotype%Genotype%Genes
目的 对比研究鲍曼不动杆菌临床分离株基因型和编码耐药基因的差异,并分析其与临床多重耐药性的关系.方法 随机收集中南大学湘雅二医院2008年9月至2009年9月分离的77株鲍曼不动杆菌,采用WHO推荐的K-B法对鲍曼不动杆菌进行临床常见15种抗生素药物敏感试验,并对药敏谱进行分析.用随机扩增多态性DNA法(RAPD)技术进行基因分型.并利用PCR对β-内酰胺酶基因TEM-1、IMP、OXA-23、OXA-24、AmpC和氨基糖苷类修饰酶基因aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ和16S rRNA甲基化基因armA、rmtA、rmtB进行扩增及序列分析.对比分析鲍曼不动杆菌耐药基因的携带情况,以及与基因型和耐药性的关系.结果 77株鲍曼不动杆菌中敏感菌株有31株,对5种或5种以上抗生素耐药的多重耐药菌株46株,内含全耐药菌株10株.RAPD技术将其分为17型,为A-G型,多重耐药株中E型为优势克隆株(17株),在重症监护病房(ICU)中流行最广,占47.1%(8/17).敏感株中各型散在分布.PCR扩增结果显示,多重耐药株和敏感株携带TEM-1、IMP、OXA-23、OXA-24、AmpC、aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ和armA耐药基因的比率分别为95.7%、39.1%、84.8%、54.3%、87.0%、89.1%、84.8%、45.7%、63.0%和58.1%、9.7%、32.3%、48.4%、48.4%、29.0%、45.2%、12.9%、9.7%,未发现rmtA和rmtB基因阳性菌株.经x2检验,除OXA-24外,其余各耐药基因携带率比较差异有统计学意义(P＜0.05).药敏分析提示携带以上耐药基因的鲍曼不动杆菌菌株的耐药率明显高于未携带该基因的菌株,其中对阿米卡星和庆大霉素耐药的菌株,其氨基糖苷类酶基因均阳性(34.8%),含所测的所有β-内酰胺酶基因的菌株均为全耐药株.结论 与临床分离的敏感鲍曼不动杆菌相比,多重耐药株耐药谱广,耐药率高,其携带β-内酰胺酶基因和氨基糖苷类酶基因种类多,分离率高,且同一克隆的多重耐药株可在病室内和病室间传播.
目的 對比研究鮑曼不動桿菌臨床分離株基因型和編碼耐藥基因的差異,併分析其與臨床多重耐藥性的關繫.方法 隨機收集中南大學湘雅二醫院2008年9月至2009年9月分離的77株鮑曼不動桿菌,採用WHO推薦的K-B法對鮑曼不動桿菌進行臨床常見15種抗生素藥物敏感試驗,併對藥敏譜進行分析.用隨機擴增多態性DNA法(RAPD)技術進行基因分型.併利用PCR對β-內酰胺酶基因TEM-1、IMP、OXA-23、OXA-24、AmpC和氨基糖苷類脩飾酶基因aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ和16S rRNA甲基化基因armA、rmtA、rmtB進行擴增及序列分析.對比分析鮑曼不動桿菌耐藥基因的攜帶情況,以及與基因型和耐藥性的關繫.結果 77株鮑曼不動桿菌中敏感菌株有31株,對5種或5種以上抗生素耐藥的多重耐藥菌株46株,內含全耐藥菌株10株.RAPD技術將其分為17型,為A-G型,多重耐藥株中E型為優勢剋隆株(17株),在重癥鑑護病房(ICU)中流行最廣,佔47.1%(8/17).敏感株中各型散在分佈.PCR擴增結果顯示,多重耐藥株和敏感株攜帶TEM-1、IMP、OXA-23、OXA-24、AmpC、aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ和armA耐藥基因的比率分彆為95.7%、39.1%、84.8%、54.3%、87.0%、89.1%、84.8%、45.7%、63.0%和58.1%、9.7%、32.3%、48.4%、48.4%、29.0%、45.2%、12.9%、9.7%,未髮現rmtA和rmtB基因暘性菌株.經x2檢驗,除OXA-24外,其餘各耐藥基因攜帶率比較差異有統計學意義(P＜0.05).藥敏分析提示攜帶以上耐藥基因的鮑曼不動桿菌菌株的耐藥率明顯高于未攜帶該基因的菌株,其中對阿米卡星和慶大黴素耐藥的菌株,其氨基糖苷類酶基因均暘性(34.8%),含所測的所有β-內酰胺酶基因的菌株均為全耐藥株.結論 與臨床分離的敏感鮑曼不動桿菌相比,多重耐藥株耐藥譜廣,耐藥率高,其攜帶β-內酰胺酶基因和氨基糖苷類酶基因種類多,分離率高,且同一剋隆的多重耐藥株可在病室內和病室間傳播.
목적 대비연구포만불동간균림상분리주기인형화편마내약기인적차이,병분석기여림상다중내약성적관계.방법 수궤수집중남대학상아이의원2008년9월지2009년9월분리적77주포만불동간균,채용WHO추천적K-B법대포만불동간균진행림상상견15충항생소약물민감시험,병대약민보진행분석.용수궤확증다태성DNA법(RAPD)기술진행기인분형.병이용PCR대β-내선알매기인TEM-1、IMP、OXA-23、OXA-24、AmpC화안기당감류수식매기인aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ화16S rRNA갑기화기인armA、rmtA、rmtB진행확증급서렬분석.대비분석포만불동간균내약기인적휴대정황,이급여기인형화내약성적관계.결과 77주포만불동간균중민감균주유31주,대5충혹5충이상항생소내약적다중내약균주46주,내함전내약균주10주.RAPD기술장기분위17형,위A-G형,다중내약주중E형위우세극륭주(17주),재중증감호병방(ICU)중류행최엄,점47.1%(8/17).민감주중각형산재분포.PCR확증결과현시,다중내약주화민감주휴대TEM-1、IMP、OXA-23、OXA-24、AmpC、aac(3)-Ⅰ、aac(6')-Ⅰ、ant(3")-Ⅰ화armA내약기인적비솔분별위95.7%、39.1%、84.8%、54.3%、87.0%、89.1%、84.8%、45.7%、63.0%화58.1%、9.7%、32.3%、48.4%、48.4%、29.0%、45.2%、12.9%、9.7%,미발현rmtA화rmtB기인양성균주.경x2검험,제OXA-24외,기여각내약기인휴대솔비교차이유통계학의의(P＜0.05).약민분석제시휴대이상내약기인적포만불동간균균주적내약솔명현고우미휴대해기인적균주,기중대아미잡성화경대매소내약적균주,기안기당감류매기인균양성(34.8%),함소측적소유β-내선알매기인적균주균위전내약주.결론 여림상분리적민감포만불동간균상비,다중내약주내약보엄,내약솔고,기휴대β-내선알매기인화안기당감류매기인충류다,분리솔고,차동일극륭적다중내약주가재병실내화병실간전파.
Objective To investigate the genotypes and encoding resistance genes differences of Acinetobacter baumannii and analyze their interrelations with multi-drug resistance.Methods A total of 77strains Acinetobacter baumannii were collected random from the second Xiangya Hospital during September 2008 to September 2009.The K-B method which was WHO recommended was adopted to Acinetobacter baumannii drug sensitivity test to 15 kinds of antibiotics to establish susceptibility spectrum.At the same time,random amplified polymorphic DNA(RAPD)technique was used to establish DNA fingerprinting.The genes of β-lactamase(TEM-1,IMP,OXA-23,OXA-24,AmpC),aminoglycoside-modifying enzymes[aac(3')-Ⅰ ,aac(6')-Ⅰ ,ant(3")-Ⅰ]and 16S rRNA methylase(armA,rmtA,rmtB)were detected by PCR and sequenced,and find the relationship between the gene encoding and multi-drug resistance.In addition,we compared the rates of resistance genes of Acinetobacter baumannii and the relations with the genotype and the multi-resistance.Results Thirty-one sensitive strains and 46 multi-drug resistance strains(10 Pan-drug resistances)were isolated.Seventeen types from A to Q were separated using RAPD technique.E genotype widely popular in the ICU was the advantage type in multi-drug resistance strains,and the rate was 47.1%.While the various types scattered in sensitive strains.The positive rates of TEM-1,IMP,OXA-23,OXA-24,AmpC,aac(3')-Ⅰ ,aac(6')-Ⅰ ,ant(3")-Ⅰ ,armA in the multi-drug resistance strains and the sensitive strains were 95.7%,39.1%,84.8% ,54.3%,87.0%,89.1%,84.8%,45.7%,63.0% and 58.1%,9.7%,32.3%,48.4%,48.4%,29.0%,45.2%,12.9%,9.7%,respectively,and there was significant difference except for OXA-24 using the X2 test(P ＜ 0.05).All isolates were negative for rmtA gene and rmtB gene.Drug susceptibility analysis showed that the resistant rate was significantly higher of the strains carrying resistant genes than that of the resistance negative strains.When the strains were resistant to gentamicin and amikacin,the rate of three aminoglycoside genes positive was 34.8%.The trains containing all the measured β-lactamase genes were all resistant strains.Conclusion Compared with the sensitive Acinetobacter baumannii strains,a broad resistance spectrum and a high drug resistance rate were showed in multidrug resistance strains isolated from clinic,which harboring many kinds of β-lactamase genes and aminoglycosides genes with a high separation rate,and the same clone of multiple drug-resistant strains may be transmitted in and among wards.
