鲍曼不动杆菌耐药性及碳青霉烯酶研究.docVIP

鲍曼不动杆菌耐药性及碳青霉烯酶研究 　　【摘要】 目的 了解鲍曼不动杆菌耐药谱及碳青霉烯酶的研究。方法 用VITEK60型全自动药敏分析系统鉴定药敏系统及纸片扩散法进行药敏实验；PCR扩增和测序分析检测碳青霉烯酶VIM、IMP、OXA-23和OXA-24。结果 217株鲍曼不动杆菌中头孢哌酮/舒巴坦耐药率最低，其次是亚胺培南，再者是头孢他啶和哌拉西林/他唑巴坦；头孢哌酮/舒巴坦和头孢他啶的中介率分别是27.6%和19.8%； 20株亚胺培南耐药菌中， PCR 扩增VIM、IMP和OXA-24均阴性；OXA-23基因扩增显示19株（95%）阳性，PCR产物并经序列分析证实为OXA-23。结论 碳青霉烯类抗生素的长期广泛应用使鲍曼不动杆菌的耐药率不断升高；产OXA-23型β-内酰胺酶是本院鲍曼不动杆菌对亚胺培南耐药的重要原因。? 　　【关键词】 鲍曼不动杆菌；碳青霉烯酶 　　 　　The resistant characteristic and carbapenemases in acinetobacter baumannii 　　FENG Hong-jun, NIU Li-lin, LI Hua-ru,et al.The First People’s Hospital of Pingdingshan， Henan 467000，China 　　【Abstract】 ObjectiveTo investigate the resistant characteristic and carbapenemases in acinetobacter Baumannii（Ab）.Methods Identification and analyses all specimens were identified by VITEK- 60, drug resistances were detected by VITEK- 60 , the drug resistance to SCF were detected by Kirby -Bauer test. PCR and DNA sequencing were performed to determine VIM，IMP，OXA-23 and OXA-24 β-lactamase. Results 217 strains, the resistance rate to sulperazone in 217 strains is the lowest, then to the Imipem’s ;The mid-drug-resistance rate of the sulperazone is 27.6%, and the ceftazidime’s is 19.8%. Of the 20 imipenem resistance strains, VIM、IMP and OXA-24 β-lactamase genotype were all negative, PCR and sequencing found 19 strains（95%）produced OXA-23.Conclusion The resistance rates is increasing to advance as longer-term or broad to use carbopenem; OXA-23 production is the important resistance mechanism in Imipenem.? 　　【Key words】 Acinetobacter baumannii；Carbapenemases 　　 　　鲍曼不动杆菌是引起院内感染的重要病原菌,它对多种抗菌药物耐药, 临床上治疗比较困难。亚胺培南对不动杆菌有较好的抗菌活性, 往往是鲍曼不动杆菌院内感染的首选抗菌药物[1]。但随着亚胺培南在临床的广泛应用, 对亚胺培南耐药的不动杆菌也日益增多[2]。为了解亚胺培南耐药鲍曼不动杆菌在本院的耐药性及流行情况,笔者对在本院收集到的亚胺培南耐菌株进行耐药性分析, 并对碳青霉烯酶基因进行了检测。? 　　 　　1 材料和方法? 　　 　　1.1 收集本院2005年12月至2006年12月间住院患者各类标本中分离出多重耐药菌株217株，其中来自痰液的159株，疮口分泌物21株，尿液7株，腹水6株，血液5株，其他标本26株。并取对亚胺培南耐药菌株20株进行碳青霉烯酶基因进行了检测。? 　　1.2 分离培养 按《全国临床检验操作规程》进行细菌分离培养。? 　　1.3 质控菌株 大肠埃希菌(ATCC 25922)，铜绿假单胞菌(ATCC 27853)。? 　　1.4 鉴定