创伤外科耐碳青霉烯类鲍曼不动杆菌碳青霉烯酶基因型检测
Analysis of the Carbapenemase Genotype in the Carbapenem-resistant Acinetobacter Baumannii in Traumatology Department
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摘要: 目的 了解昆明医科大学第四附属医院创伤外科临床分离的鲍曼不动杆菌D类碳青霉烯酶的基因型, 为临床合理使用抗菌药物及预防院内感染提供参考.方法 收集昆明医科大学第四附属医院创伤外科临床分离的非重复鲍曼不动杆菌96株, 分析患者资料, 应用聚合酶链反应 (polymerase chain reaction, PCR) 检测OXA-51、OXA-23、ISAba1-oxa-51、ISAba1-oxa-23 4种碳青霉烯酶基因.结果 在96株鲍曼不动杆菌中, 70.84% (68株) 分离自创口组织;在检测的12种抗菌药物中, 96株鲍曼不动杆菌对亚胺培南的耐药率最高 (78.13%) , 左氧氟沙星的耐药率最低 (43.75%) ;在23株亚胺培南敏感的鲍曼不动杆菌中, 有4株未检测到OXA-51, 5株观察到OXA-23表达;73株亚胺培南不敏感的鲍曼不动杆菌中, OXA-51、OXA-23、ISAba1-oxa-51、ISAba1-oxa-23基因的检出率分别是100%、95.89%、79.45%、71.23%.OXA-51+ISAba1-oxa-51+OXA-23+ISAba1-oxa-23基因表达模式检出率为65.75%.结论 亚胺培南敏感的鲍曼不动杆菌可能存在D类碳青霉烯酶OXA-23的表达;该院创伤外科耐碳青霉烯类鲍曼不动杆菌产碳青霉烯酶的主要模式为OXA-51+ISAba1-oxa-51+OXA-23+ISAba1-oxa-23, 这可能是导致该菌对碳青霉烯类抗菌药物耐药性高的机制之一.Abstract: Objective To investigate the genotype of D class of carbapenemase of carbapenem-resistant Acinetobacter baumannii in traumatology department, so as to guide the rational use of antibiotics as well as prevent the nosocomial infection. Me thods A total of 96 strains of Acinetobacter baumannii were collected in traumatology department. Patient history were analyzed and genotype of carbapenemases of OXA-51, OXA-23, ISAba1-oxa-51 and ISAba1-oxa-23 were analyzed by PCR.Re s ults 70.84% (68/96) of Acinetobacter baumannii were isolated from wound tissue. 12 antibacterial agents were tested, 96 strains of Acinetobacter baumannii showed the highest resistance rate (78.13%) to imipenem and the lowest resistance rate (43.75%) to levofloxacin. Among 23 strains of imipenem-sensitive Acinetobacter baumannii, OXA-51 gene expression was not detected in 4 strains, however, OXA-23 gene expression were observed in 5 strains. The gene expression rates of OXA-51, OXA-23, ISAba1-oxa-51 and ISAba1-oxa-23 genes were 100%, 95.89%, 79.45% and 71.23% respectively in 73 strains of imipenem-insensitive Acinetobacter baumannii. The rate of gene expression profile of OXA-51+ISAba1-oxa-51+OXA-23+ISAba1-oxa-23 was 65.75%.Conclus ion The strains of imipenem-sensitive Acinetobacter baumannii may have the gene expression of OXA-23 of D class of carbapenemase.The main pattern of carbapenemase-producing was OXA-51+ISAba1-oxa-51+OXA-23+ISAba1-oxa-23 in traumatology department, which might be regarded as one of the mechanisms that led to the high resistance of the bacterium of acinetobacter baumannii to carbapenem antibiotics.
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Key words:
- Acinetobacter baumannii /
- Carbapenase /
- Genotype /
- Traumatology department
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