亚胺培南耐药型鲍曼不动杆菌的耐药机制与分子流行病学研究

目的：了解亚胺培南耐药型鲍曼不动杆菌分子流行病学特点，研究鲍曼不动杆菌的耐药机制。方法：收集我院亚胺培南耐药型鲍曼不动杆菌（imipenem resistant acinetobacter baumannii, IRAB）共17株，E-test进行药敏试验，PFGE技术分析耐药菌株同源性，改良Hodge试验筛选产碳青霉烯类耐药菌株，PCR扩增bla基因并进行基因序列的测序和分析。结果：17株亚胺培南耐药型鲍曼不动杆菌分别来自病人痰液、伤口、血液标本，药敏检测发现17株菌具有多重耐药性，PFGE分析表明17株菌可分为A、B、C、D4个克隆型，其中A型包括A1和A2两个亚型，改良Hodge试验和PCR基因扩增证实17株菌均含OXA-23型基因。结论：产OXA-23型碳青霉烯酶是本研究中鲍曼不动杆菌对亚胺培南等碳青霉烯类抗生素耐药的主要机制之一。

Resistance mechanism and molecular epidemiology of resistant strains bauman of imipenem

Objective： To investigate resistance mechanism and molecular epidemiology of resistant strains bauman of imipenem. Methods： A total of 17 strains of imipenem resistant acinetobacter （Bauman imipenem resistant acinetobacter baumannii IRAB） were collected. E-test was used in drug sensitive test, and homology of resistant strains was analyzed by PFGE technology. Carbapenem resistant strains were scanned by the modified Hodge test. Sequencing and analysis of amplified BLA gene and gene sequence was performed by PCR. Results： 17 strains of imipenem resistant acinetobacter Bauman were from sputum, wound, blood samples. It showed that detected 17 strains had multi drug resistance, PFGE analysis showed that 17 strains could be divided into A, B, C, D four clones. Type A included A1 and two subtypes of A2. Modified Hodge test and PCR amplification confirmed that 17 strains contained OXA-23 gene. Conclusion： OXA-23 type carbapenemase is resistance mechanism of imipenem to carbapenem antibiotics.