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目的调查深圳市人民医院呼吸科住院患者耐碳青霉烯鲍曼不动杆菌(CRAB)的抗菌药物敏感性和耐药分子机制,以及克隆流行情况。方法收集2010年深圳市人民医院呼吸科住院患者临床分离CRAB 29株,琼脂稀释法测定亚胺培南等15种抗菌药对CRAB的最低抑菌浓度(MIC),PCR和DNA测序分析CRAB碳青霉烯酶基因型,脉冲场凝胶电泳(PFGE)分析菌株同源性。结果多粘菌素B对29株CRAB抗菌活性最强,敏感性100%,MIC50/MIC90为1/1μg/mL,其次米诺环素,敏感性96.6%,MIC50/MIC90为4/4μg/mL,替加环素中介率高达96.6%,MIC50/MIC90为4/4μg/mL。96.6%(28/29)CRAB携带ISAba1-blaOXA-23-like,对亚胺培南和美罗培南高度耐药,亚胺培南和美罗培南的MIC集中分布在32~64μg/mL;1株携带ISAba1-blaOXA-51-likeCRAB,对亚胺培南和美罗培南中度耐药,亚胺培南和美罗培南的MIC分别为4μg/mL和8μg/mL。29株CRAB未发现blaOXA-24-like、blaOXA-143-like、金属酶基因及KPC酶基因。29株CRAB经PFGE分型共分2型,以A型28株(96.6%)为主要流行克隆,均携带ISAba1-blaOXA-23-like。结论 2010年我院呼吸科临床分离CRAB主要携带ISAba1-blaOXA-23-like基因,并以克隆播散流行。
Objective To investigate the antimicrobial susceptibility and drug resistance mechanism of carbapenem-resistant Acinetobacter baumannii (CRAB) inpatients in the Respiratory Department of Shenzhen People’s Hospital and to investigate the prevalence of the cloning. Methods A total of 29 CRAB isolates were collected from inpatients of respiratory department of Shenzhen People’s Hospital in 2010 and the minimum inhibitory concentration (MIC) of 15 antibacterials such as imipenem on CRAB were determined by agar dilution method. PCR and DNA sequencing were used to analyze CRAB Mycoplasma genotypes and pulsed-field gel electrophoresis (PFGE) were used to analyze the homology of the strains. Results Polymyxin B had the highest antibacterial activity against 29 strains of CRAB with a sensitivity of 100% and a MIC50 / MIC90 of 1/1 μg / mL, followed by minocycline with a sensitivity of 96.6% and MIC50 / MIC90 of 4/4 μg / mL , Tigecycline was as high as 96.6%, MIC50 / MIC90 was 4 / 4μg / mL. 96.6% (28/29) of CRABs were highly resistant to imipenem and meropenem with ISAba1-blaOXA-23-like. MICs of imipenem and meropenem were concentrated in 32-64μg / mL. One strain carrying ISAba1- The blaOXA-51-likeCRAB was moderately resistant to imipenem and meropenem with MICs of 4 μg / mL and 8 μg / mL for imipenem and meropenem, respectively. No blaOXA-24-like, blaOXA-143-like, metalloenzyme and KPC genes were found in 29 CRABs. 29 strains of CRAB were divided into 2 types according to PFGE classification and 28 strains (96.6%) of type A were cloned as major epidemics, carrying ISAba1-blaOXA-23-like. Conclusion CRAB in clinical isolates of respiratory department of our hospital in 2010 mainly carry ISAba1-blaOXA-23-like gene, and clonal dissemination is popular.