烧伤病房鲍曼不动杆菌耐药性及OXA基因型检测

目的:了解烧伤病房患者创面鲍曼不动杆菌的耐药性和OXA碳青霉烯酶基因携带情况,为预防和控制多重耐药鲍曼不动杆菌医院感染提供依据.方法:收集2013年1月—2015年12月皖南医学院第一附属医院烧伤整形外科收治2572例患者创面分泌物进行细菌培养;使用VITEK2 Compact型全自动微生物检测仪鉴定鲍曼不动杆菌,通过药敏实验检测其对18种抗菌药物的敏感性;应用聚合酶链反应(PCR)方法检测4种OXA碳青霉烯酶基因(OXA-23-like、OXA-24-like、OXA-51-like、OXA-58-like)的携带情况,并对其中10株进行OXA-23-like基因测序.结果:分离出44株鲍曼不动杆菌,对亚胺培南耐药率为79.55%(27株),对米诺环素及替加环素的耐药率较低,分别为20.45%(9株)和31.82%(14株),对庆大霉素耐药率高达100%,对其他抗菌药物也具有较高的耐药率(59.09%~97.73%).所有菌株OXA-51-like基因均为阳性,共有35株OXA-23-like基因阳性(阳性率79.55%),均未检测到OXA-24-like基因和OXA-58-like基因.结论:鲍曼不动杆菌呈多重耐药现象,对米诺环素耐药率最低,我院创面鲍曼不动杆菌主要耐药机制可能与OXA-23-like基因有关.

Detection of drug resistance and OXA genotypes in Acinetobacter baumannii isolated from patients of burn units

Objective: To investigate the drug resistance and OXA gene carrying case of Acinetobacter baumannii isolated from burn patients to provide a basis for prevention and control of hospital infection induced by multi-drug resistant Acinetobacter baumannii.Methods: Bacterial culture of wound secretion was performed in 2572 burn patients admitted to the Burns and Plastic Surgery of the First Affiliated Hospital of Wannan Medical College from January 2013 to February 2015. VITEK 2 Compact automatic microbial detection system was used to identify Acinetobacter baumanii, and its susceptibility to 18 kinds of antimicrobial were tested. Four kinds of OXA carbapenemase genes (OXA-23-like, OXA-24-like, OXA-51-like, OXA-58-like) in Acinetobacter baumannii were detected by polymerase chain reaction, and OXA-23-like gene was sequenced in 10 strains.Results: Totally 44 strains of Acinetobacter baumannii were isolated, and the resistance rate to imipenem was 79.55% ( 27 strains), they were lower to Minocyline and tigecycline (20.45%, 9 strains and 31.82%,14 strains respectively) , but high (100%) to gentamicin, and maintained at higher resistance rate to other antibiotics (59.09%-97.73%). In all strains of Acinetobacter baumannii, the OXA-51-like genes were positive, and a total of 35 OXA-23-like genes-positive strains (79.55%) were detected, while no OXA-24-like gene and OXA-58-like gene positive strains were found.Conclusions:Acinetobacter baumannii showed multiple drug resistance, the resistance rate to minocycline is low. The mechanism of multi-drug resistance of Acinetobacter baumannii in our hospital may be related mainly to OXA-23-like genes.