检验医学
檢驗醫學
검험의학
LABORATORY MEDICINE
2015年
1期
53-57
,共5页
张广慧%曹雪萍%俞静%刘瑛%葛艳
張廣慧%曹雪萍%俞靜%劉瑛%葛豔
장엄혜%조설평%유정%류영%갈염
鲍曼不动杆菌%β-内酰胺酶%外排泵%重复序列聚合酶链反应%实时荧光定量聚合酶链反应
鮑曼不動桿菌%β-內酰胺酶%外排泵%重複序列聚閤酶鏈反應%實時熒光定量聚閤酶鏈反應
포만불동간균%β-내선알매%외배빙%중복서렬취합매련반응%실시형광정량취합매련반응
Acinetobacter baumannii%beta-lactamase%Efflux pump%Repetitive-sequence polymerase chain reaction%Real-time fluorescence quantitation polymerase chain reaction
目的：了解耐碳青霉烯类抗菌药物的鲍曼不动杆菌流行病学情况以及耐药机制，帮助临床合理使用抗菌药物，为控制医院感染提供依据。方法收集耐碳青霉烯类抗菌药物的鲍曼不动杆菌110株及敏感株6株，进行来源病区和标本种类的统计分析；应用重复序列聚合酶链反应（REP-PCR）进行基因型分型；使用PCR检测β-内酰胺酶基因（OXA、IMP、VIM等）及外排泵编码基因（adeA、adeB、adeC、adeJ、adeG）的携带情况；采用实时荧光定量PCR对比耐药菌株与敏感菌株的外排泵基因表达量的差异。结果110株菌株主要来自痰标本，重症监护病房（ICU）分离率最高；所有菌株REP-PCR电泳图谱分为A～G 7型，110株耐药菌株均为A型，且均被检测到含有OXA-23、OXA-51基因，均未检测到含有OXA-24、OXA-58、IMP-1、IMP-2、VIM-1、VIM-2基因；外排泵编码基因adeA、adeB、adeC、adeJ及adeG的阳性率均为100％；耐药菌株外排泵编码基因adeA、adeB、adeC表达量明显高于敏感菌株。结论耐碳青霉烯类鲍曼不动杆菌的流行型别基本相同，均为A型，应引起临床医护人员的高度重视；β-内酰胺酶基因（OXA-23、OXA-51）的表达以及外排泵基因（adeA、adeB、adeC）的过度表达与其对碳青霉烯类抗菌药物的耐药性有关。
目的：瞭解耐碳青黴烯類抗菌藥物的鮑曼不動桿菌流行病學情況以及耐藥機製，幫助臨床閤理使用抗菌藥物，為控製醫院感染提供依據。方法收集耐碳青黴烯類抗菌藥物的鮑曼不動桿菌110株及敏感株6株，進行來源病區和標本種類的統計分析；應用重複序列聚閤酶鏈反應（REP-PCR）進行基因型分型；使用PCR檢測β-內酰胺酶基因（OXA、IMP、VIM等）及外排泵編碼基因（adeA、adeB、adeC、adeJ、adeG）的攜帶情況；採用實時熒光定量PCR對比耐藥菌株與敏感菌株的外排泵基因錶達量的差異。結果110株菌株主要來自痰標本，重癥鑑護病房（ICU）分離率最高；所有菌株REP-PCR電泳圖譜分為A～G 7型，110株耐藥菌株均為A型，且均被檢測到含有OXA-23、OXA-51基因，均未檢測到含有OXA-24、OXA-58、IMP-1、IMP-2、VIM-1、VIM-2基因；外排泵編碼基因adeA、adeB、adeC、adeJ及adeG的暘性率均為100％；耐藥菌株外排泵編碼基因adeA、adeB、adeC錶達量明顯高于敏感菌株。結論耐碳青黴烯類鮑曼不動桿菌的流行型彆基本相同，均為A型，應引起臨床醫護人員的高度重視；β-內酰胺酶基因（OXA-23、OXA-51）的錶達以及外排泵基因（adeA、adeB、adeC）的過度錶達與其對碳青黴烯類抗菌藥物的耐藥性有關。
목적：료해내탄청매희류항균약물적포만불동간균류행병학정황이급내약궤제，방조림상합리사용항균약물，위공제의원감염제공의거。방법수집내탄청매희류항균약물적포만불동간균110주급민감주6주，진행래원병구화표본충류적통계분석；응용중복서렬취합매련반응（REP-PCR）진행기인형분형；사용PCR검측β-내선알매기인（OXA、IMP、VIM등）급외배빙편마기인（adeA、adeB、adeC、adeJ、adeG）적휴대정황；채용실시형광정량PCR대비내약균주여민감균주적외배빙기인표체량적차이。결과110주균주주요래자담표본，중증감호병방（ICU）분리솔최고；소유균주REP-PCR전영도보분위A～G 7형，110주내약균주균위A형，차균피검측도함유OXA-23、OXA-51기인，균미검측도함유OXA-24、OXA-58、IMP-1、IMP-2、VIM-1、VIM-2기인；외배빙편마기인adeA、adeB、adeC、adeJ급adeG적양성솔균위100％；내약균주외배빙편마기인adeA、adeB、adeC표체량명현고우민감균주。결론내탄청매희류포만불동간균적류행형별기본상동，균위A형，응인기림상의호인원적고도중시；β-내선알매기인（OXA-23、OXA-51）적표체이급외배빙기인（adeA、adeB、adeC）적과도표체여기대탄청매희류항균약물적내약성유관。
Objective To understand the drug resistance mechanisms and epidemiology of carbapenem-resistant Acinetobacter baumannii in order to guide the rational use of antibiotics and to provide the reference for the control of nosocomial infections.Methods A total of 1 16 Acinetobacter baumannii (1 10 carbapenem-resistant isolates and 6 carbapenem-sensitive isolates)isolated from clinical specimens were classified and analyzed according to endemic areas and specimen types.The isolates were analyzed by repetitive-sequence polymerase chain reaction (REP-PCR)for genotyping.Beta-lactamase genes (OXA,IMP,VIM and soon)and efflux pump-encoding genes (adeA,adeB,adeC, adeJ,adeG)were amplified by PCR.Real-time fluorescence quantitation PCR was performed to compare the expression level of the efflux pump-encoding genes in resistant and sensitive isolates.Results The isolation rate of resistant isolates in intensive care unit (ICU )was the highest-level,and the isolates were mainly isolated from sputum.The genotype types of carbapenem-resistant and -sensitive Acinetobacter baumannii were classified into 7 categories by REP-PCR.All the carbapenem-resistant isolates were type A.OXA-23 and OXA-5 1 were positive in 1 10 carbapenem-resistant isolates.However,OXA-24,OXA-58,IMP-1,IMP-2,VIM-1 and VIM-2 could not be detected in all the isolates.The positive rates of the efflux pump-encoding genes (adeA,adeB,adeC,adeJ and adeG)were 100%.The expression level of efflux pump-encoding genes (adeA,adeB,adeC)in resistant isolates was significantly higher than that in sensitive isolates.Conclusions The main popular type of carbapenem-resistant Acinetobacter baumannii is type A. Clinical staff should pay attention to this phenomenon.The expression of OXA-23 and OXA-5 1 overexpression of adeA, adeB and adeC efflux pump-encoding gene may play an important role in carbapenem-resistant Acinetobacter baumannii.
