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目的探讨医院获得性鲍曼不动杆菌肺炎患者临床微生物学特点和治疗转归。方法回顾性调查2005年1～8月白求恩国际和平医院经分子生物学方法证实的6例医院获得性产 PER-1型超广谱β内酰胺酶(ESBL)鲍曼不动杆菌肺炎患者的临床资料。用脉冲场凝胶电泳检测6株鲍曼不动杆菌的同源性,聚合酶链反应分析相关耐药基因。结果 6株鲍曼不动杆菌中5株仅对亚胺培南敏感,4株对美罗培南敏感。脉冲场凝胶电泳将其分为 A_1型2株,A_2～A_5型各1株,携有β内酰胺酶 blaPER-1基因,同时 blaTEM-1型基因、耐消毒剂-磺胺药物基因(qacEΔ1-sul1)和1类整合子酶基因(intl1)阳性,其中3株氨基糖苷类修饰酶基因 aac(3)-Ⅰ、aac(6′)-Ⅰ同时阳性,2株 aac(3)-Ⅰ、ant(3″)-Ⅰ同时阳性,1株 aac(3)-Ⅰ单独阳性。6例患者均患有严重的基础疾病,使用过呼吸机;检出鲍曼不动杆菌前15 d 内应用过广谱抗菌药物;经使用碳青霉烯类和(或)头孢哌酮/舒巴坦抗感染治疗,3例临床好转,3例死亡。结论 6株产 PER-1型 ESBL 鲍曼不动杆菌具有高度同源性,耐药基因复杂,其所引起的医院获得性肺炎临床预后差。
Objective To investigate the clinical microbiological characteristics and treatment outcome of hospital acquired Acinetobacter baumannii pneumonia. Methods The clinical data of 6 hospital-acquired patients with Acinetobacter baumannii pneumonia who were hospital-acquired with PER-1 extended-spectrum β lactamase (ESBL) confirmed by molecular biology at Bethune International Peace Hospital from January to August 2005 were retrospectively investigated. data. The homology of 6 strains of Acinetobacter baumannii was detected by pulsed-field gel electrophoresis, and the related resistance genes were analyzed by polymerase chain reaction. Results Of the 6 Acinetobacter baumannii strains, only 5 were sensitive to imipenem and 4 were sensitive to meropenem. Pulsed field gel electrophoresis was divided into 2 strains of A_1 type and 1 strain of A_2 ~ A_5 type respectively, which contained the blaPER-1 gene of β-lactamase and the blaTEM-1 gene and the resistance agent-sulfa drug gene qacEΔ1- sul1 and intl1 were positive. AAC (3) -Ⅰ, aac (6 ’) - Ⅰ and aac (3) -Ⅰ, ant (3 ") - Ⅰ were positive at the same time, and one strain of aac (3) -I was positive alone. All 6 patients had severe underlying diseases and had used ventilator; Acinetobacter baumannii was detected in 15 days 3 antipsychotics and 3 anti-infectives after carbapenem and / or cefoperazone / sulbactam were used.Conclusion The 6 strains of PER-1 ESBL-producing Acinetobacter baumannii have High homology, drug resistance gene complex, which caused by the poor clinical prognosis of hospital-acquired pneumonia.