多重耐药鲍曼不动杆菌对替加环素耐药状况分析

目的 了解多重耐药鲍曼不动杆菌对临床常用抗生素及新药替加环素的耐药状况.方法 收集2008-2009年浙江省4所教学医院的602株临床分离鲍曼不动杆菌,采用琼脂稀释法检测其对13种临床常用抗生素的敏感性,以及对多黏菌素B和替加环素的敏感性.同时,采用PFGE技术对24株多重耐药鲍曼不动杆菌进行同源性分析,以确定菌株间的亲缘关系.结果 浙江省4家教学医院2008-2009年分离的鲍曼不动杆菌主要来自于呼吸道标本,2009年达到277株(86.0%),血液标本数量从2008年的15株(5.4%)下降到2009年的5株(1.5%),而其他标本无明显变化.鲍曼不动杆菌对临床常用的13种抗生素均有不同程度的耐药,耐药率35.0%～85.0%.与2008年相比,除左氧氟沙星和妥布霉素耐药率分别下降0.9%和9.0%以外,2009年其余抗生素耐药率均有不同程度地上升,头孢曲松和头孢吡肟耐药率增加了近10.0%,对碳青霉烯类抗生素亚胺培南和美罗培南的耐药率分别达到74.2%(239/602)和70.8%(228/602).鲍曼不动杆菌对替加环素显示了很高的耐药率,耐药率达到78.9%(475/602),而多黏菌素B耐药率仅为3.7%(22/602).PFGE分型显示2008-2009年24株鲍曼不动杆菌有6个克隆型,其中A型最常见,占50%.结论 鲍曼不动杆菌对替加环素的耐药加大了院内感染控制的难度,临床应加强控制,防止多重耐药菌的传播.     

多重耐药鲍曼不动杆菌对替加环素耐药状况分析

目的 了解多重耐药鲍曼不动杆菌对临床常用抗生素及新药替加环素的耐药状况.方法 收集2008-2009年浙江省4所教学医院的602株临床分离鲍曼不动杆菌,采用琼脂稀释法检测其对13种临床常用抗生素的敏感性,以及对多黏菌素B和替加环素的敏感性.同时,采用PFGE技术对24株多重耐药鲍曼不动杆菌进行同源性分析,以确定菌株间的亲缘关系.结果 浙江省4家教学医院2008-2009年分离的鲍曼不动杆菌主要来自于呼吸道标本,2009年达到277株(86.0%),血液标本数量从2008年的15株(5.4%)下降到2009年的5株(1.5%),而其他标本无明显变化.鲍曼不动杆菌对临床常用的13种抗生素均有不同程度的耐药,耐药率35.0%～85.0%.与2008年相比,除左氧氟沙星和妥布霉素耐药率分别下降0.9%和9.0%以外,2009年其余抗生素耐药率均有不同程度地上升,头孢曲松和头孢吡肟耐药率增加了近10.0%,对碳青霉烯类抗生素亚胺培南和美罗培南的耐药率分别达到74.2%(239/602)和70.8%(228/602).鲍曼不动杆菌对替加环素显示了很高的耐药率,耐药率达到78.9%(475/602),而多黏菌素B耐药率仅为3.7%(22/602).PFGE分型显示2008-2009年24株鲍曼不动杆菌有6个克隆型,其中A型最常见,占50%.结论 鲍曼不动杆菌对替加环素的耐药加大了院内感染控制的难度,临床应加强控制,防止多重耐药菌的传播.     

整合子在鲍曼不动杆菌耐药中的作用研究

Objective To investigate the drug-resistant status of Acinetobacter baumannii in clinical strains isolated from our hospital,and get to know the distribution of integrons carried by Acinetobacter baumannii,analyze the correlation between integron and drug-resistant of Acinetobacter baumannii..Methods Collected 85 Acinetobacter baumannii isolated in our lab,the drug-sensitivity tests were completed by the method of KB,the integrase genes were amplified by polymerase chain reaction(PCR),and identified the type of integron..Analyzed the correlation between the drug-resistant and integron in Acinetobacter baumannii..The open reading frame of integron were amplified by PCR,the polymorphism of integron was identified,and sequenced the PCR products.Results Except for Imipenem and Cefoperazone/ sulbactam(drug resistant rate less than 10%),the drug resistant rate of other 15 antibacterial was no more than 30% among the 85 Acinetobacter baumannii isolated in our lab..66.1 %(57/85) stains carried the integrons I,we didn't find out the integron Ⅱ and Ⅲ.The drug-resistant rates of Acinetobacter baumannii with integron were higher than that of Acinetobacter baumannii without integron.The length of amplified products in variable region of open reading frame of integron varied from 03 to 25kb,.The sequencing results confirmed the integron included multidrug resistant gene code.Conclusion In our hospital,the drug-resistant rate of Acinetobacter baumannii was high,and the majority were multidrug resistant strains.The drug-resistant rate of Acinetobacter baumannii was enhanced with integron,The multidrug resistant of Acinetobacter baumannii was associated with integrons.     

整合子在鲍曼不动杆菌耐药中的作用研究

Objective To investigate the drug-resistant status of Acinetobacter baumannii in clinical strains isolated from our hospital,and get to know the distribution of integrons carried by Acinetobacter baumannii,analyze the correlation between integron and drug-resistant of Acinetobacter baumannii..Methods Collected 85 Acinetobacter baumannii isolated in our lab,the drug-sensitivity tests were completed by the method of KB,the integrase genes were amplified by polymerase chain reaction(PCR),and identified the type of integron..Analyzed the correlation between the drug-resistant and integron in Acinetobacter baumannii..The open reading frame of integron were amplified by PCR,the polymorphism of integron was identified,and sequenced the PCR products.Results Except for Imipenem and Cefoperazone/ sulbactam(drug resistant rate less than 10%),the drug resistant rate of other 15 antibacterial was no more than 30% among the 85 Acinetobacter baumannii isolated in our lab..66.1 %(57/85) stains carried the integrons I,we didn't find out the integron Ⅱ and Ⅲ.The drug-resistant rates of Acinetobacter baumannii with integron were higher than that of Acinetobacter baumannii without integron.The length of amplified products in variable region of open reading frame of integron varied from 03 to 25kb,.The sequencing results confirmed the integron included multidrug resistant gene code.Conclusion In our hospital,the drug-resistant rate of Acinetobacter baumannii was high,and the majority were multidrug resistant strains.The drug-resistant rate of Acinetobacter baumannii was enhanced with integron,The multidrug resistant of Acinetobacter baumannii was associated with integrons.     

2009年中国13家教学医院院内感染病原菌的抗生素耐药性监测

目的 监测2009年我国不同地区13家教学医院院内获得病原菌的分布和体外药物敏感性.方法 收集来自13家医院院内BSI、HAP和IAI患者标本的病原菌.菌株经中心实验室复核后,采用琼脂稀释法测定替加环素等抗菌药物的MIC值,数据输入WHONET5.6软件进行耐药性分析.结果 共收集到2 502株病原菌.引起BSI的前3位病原菌分别为大肠埃希菌[27.1%(285/1 052)]、凝固酶阴性葡萄球菌[12.6%(133/1 052)]和肺炎克雷伯菌[10.8%(114/1 052)];引起HAP的前3位病原菌分别为鲍曼不动杆菌[28.8%(226/785)]、铜绿假单胞菌[16.1%(126/785)]和肺炎克雷伯菌[14.6%(115/785)];而IAI的主要病原菌为大肠埃希菌[31.0%(206/665)]、肺炎克雷伯菌[11.3%(75/665)]和屎肠球菌[10.8%(72/665)].对于大肠埃希菌和克雷伯菌,敏感率大于80%的药物包括亚胺培南和美罗培南(98.1%～100%)、替加环素(95.3%～100%)、哌拉西林-三唑巴坦(88.6%～97.1%)和阿米卡星(88.3%～92.5%).对于肠杆菌属、柠檬酸杆菌属和沙雷菌属,替加环素的敏感率为93.5%～100%,亚胺培南和美罗培南的敏感率为92.9%～100%,敏感率较高的抗萧药物还包括阿米卡星(85.2%～96.7%)、哌拉西林-三唑巴坦(82.4%～96.4%)、头孢吡肟(79.6%～96.7%)和头孢哌酮-舒巴坦(78.7%～90.0%).铜绿假单胞菌对多黏菌素B的敏感率最高(100%),其次为阿米卡星和哌拉西林-三唑巴坦(81.9%和80.1%).鲍曼不动杆菌对多黏菌素B的敏感率最高(98.8%),其次为替加环素(90.1%)和米诺环素(72.O%).CRAB的发生率为60.1%.金黄色葡萄球菌中MRSA的发生率为60.2%,凝固酶阴性葡萄球菌中MRSCoN的发生率为84.2%.所有葡萄球菌对替加环素、万占霉素和利奈唑胺敏感,仅有1株溶血葡萄球菌对替考拉宁中介.本次监测发现2株利奈唑胺中介的粪肠球菌和1株万古霉素和替考拉宁耐药的屎肠球菌,替加环素对这3株肠球菌的MIC值范围为0.032～0.064μg/ml.结论 替加环素、碳青霉烯类、哌拉西林-三唑巴坦、阿米卡星和头孢吡肟对医院分离的肠杆菌科菌保持了较高的抗菌活性;多黏菌素B对铜绿假单胞菌和鲍曼不动杆菌体现出高抗菌活性,替加环素对鲍曼不动杆菌抗菌活性较高;替加环素、万古霉素和替考拉宁、利奈唑胺对院内获得革兰阳性球菌保持了较高的抗菌活性.

Abstract：

Objective To investigate distribution and antimicrobial resistance among nosocomial pathogens from 13 teaching hospitals in China in 2009. Methods Non-repetitive pathogens from nosocomial BSI, HAP and IAI were collected and sent to the central lab for MIC determination by agar dilution method.WHONET5.6 software was used to analyze the data. Results A total of 2 502 clinical isolates were collected. The top three pathogens of BSI were Escherichia coli [27. 1% (285/1 052 )] , coagulase-negutive staphylococcus [12. 6% ( 133/1 052)] and Klebsiella pneumoniae [10. 8% ( 114/1 052)]. The top three pathogens of HAP were Acinetobacter baumannii [28. 8% (226/785)], Pseudomonas aeruginosa [16. 1% (126/785)] and Klebsiella pneumoniae [14.6% (115/785 )] . The top three pathogens of IAI were Escherichia coli[31.0% ( 206/665 )], Klebsiella pneumonia [11.3% ( 75/665 )] and Enterococcus faecium [10. 8% (72/665)]. Against Escherichia coil and Klebsiella spp. , the antimicrobial agents with higher than 80% susceptibility rate included imipenem and meropenem (98. 1%-100% ), tigecycline (95.3%-100% ), piperacillin-tazobactam ( 88.6% -97. 1% ) and amikacin ( 88. 3% -92. 5% ). Against Enterobacter spp. , Citrobacter spp. and Serratia spp. , the susceptibility rates of tigecycline were 93.5% -100% whereas the value of imipenem and meropenem were 92.9% -100%. Other antimicrobial agents with high activity included amikacin ( 85.2% -96. 7% ), pipcracillin-tazobactam ( 82.4% -96.4% ), cefepime ( 79. 6% -96. 7% ) and cefoperazonc-sulbactam (78. 7%-90. 0% ). Polymyxin B showed the highest susceptibility rateagainst Pseudomonas aeruginosa ( 100% ), followed by amikacin ( 81.9% ) and piperacillin-tazobactam (80.1% ). Polymyxin B also showed the highest susceptibility rate against Acinetobacter baumannii (98. 8% ), followed by tigecycline (90. 1% ) and minocycline (72. 0% ). The incidence of carbapenemresistant Acinetobacter baumannii was 60. 1%. The MRSA rate was 60. 2% and the MRSCoN rate was 84. 2%. All Staphylococcus strains were susceptible to tigecycline, vancomycin, teicoplanin and linezolid except for one isolate of Staphylococcus haemolysis with intermediate to teicoplanin. Two Enterococcus faecalis isolates which were intermediate to linezolid and one Enterococcus faecium isolate which was resistant to vancomycin and teicoplanin was found in this surveillance, while the MICs of tigecycline against these three isolates were 0. 032-0. 064 μg/ml. Conclusions Tigecycline, carbapenems, piperacillin-tazobactam,amikacin and cefepime remain relatively high activity against nosocomial Enterobacteriaceae. Pseudomonas aeruginosa exhibite high susceptibility to polymyxin B, while Acinetobacter baumanni shows high susceptibility to polymyxin B and tigecycline. Tigecycline, vancomycin, teicoplanin and linezolid remain high activity against nosocomial gram-positive cocci.     

耐亚胺培南鲍曼不动杆菌碳青霉烯酶及整合子分布

目的 了解耐亚胺培南鲍曼不动杆菌碳青霉烯酶及整合子分布情况.方法 收集天津医科大学总医院2008年1月至2010年3月期间,103株亚胺培南耐药鲍曼不动杆菌临床标本.用Vitek-2系统鉴定细菌,并进行药敏试验,通过改良Hodge试验、改良三维试验和2-巯基丙酸协同试验初筛碳青霉烯酶,多重PCR同时检测4种OXA型碳青霉烯酶基因、2种金属酶基因及整合酶基因,对整合子可变区进行PCR检测及序列分析.结果 103株鲍曼不动杆菌中,改良Hodge试验检出碳青霉烯酶阳性75株(72.8%),改良三维试验检出产碳青霉烯酶菌株80株(77.7%),未检出产金属酶菌株.PCR检出blaOXA-51-like+bsaOXA-23-like+int11基因84株,blaOxA-51-like+blaOXA-23-like阳性5株,blaOXA-51-like+intll阳性8株,blaOXA-51-like+blaOXA-24-like阳性2株,仅blaOXA-51-like阳性4株,blaOXA-58-like、金属酶基因(IMP-1、VIM-2)及Ⅱ类整合酶基因(intI2)均阴性.89株(96.7%)Ⅰ类整合酶阳性株均扩增出可变区,检出2种耐药基因盒组合形式:aacA4-catB8-aadAl(2 300 bp)81株,aacCl-orfX-orfX-orfX'-aadAla(3 000 bp)8株.结论 鲍曼不动杆菌对碳青霉烯类耐药及多重耐药主要与其携带的OXA-23型碳青霉烯酶和Ⅰ类整合子有关.

Abstract：

Objective To investigate the carbapenemases and integrons in imipenem-resistant Acinetobacter baumannii. Methods One hundred and three Acinetobacter baumannii were collected from Janurary 2008 to March 2010 in Tianjin Medical University General Hospital. The identification of strains and antimicrobial susceptibility test were performed by using Vitek-2 compact automatic system. Isolates of imipenem-resistant A. baumannii were screened for carbapenemases by modified Hodge test, improved threedimensional test and 2-mercaptopropionic acid synergy test. Isolates were then subjected to the multiplex PCR targeting genes encoding for OXA type carbapenemases, metallo-β-lactamases (MBLs) and integrases. The variable regions of integrons were amplificated and sequenced. Results Among the 103 isolates, 75 (72. 8% ) demonstrated positive in the modified Hodge test, 80 (77.7%)were positive in the improved three-dimensional test. No MBLs was found in the 2-mercaptopropionic acid synergy test. Eightyfour isolates were positive for blaOXA-51-like, blaOXA-23-like, and intI1; five were positive for blaOXA-51-like and blaOXA-23-like ;eight were positive for blaOXA-51-like and int11 ;two were positive for blaOXA-51-like and blaOXA-24-like ;four were only found positive for blaOXA-51-like. The blaOXA-58-like, IMP-1, VIM-2 and intI2 genes were all negative. Eighty-nine(96. 7% )of the intI1 positive strains owned the variable region. Two different cassettes arrangements were identified within class 1 integrons:81 isolates harbored aacA4-catB8-aadAI (2 300 bp) and 8 harbored aacCl-orX-orfX-orX'-aadAla (3 000 bp ) . Conclusion The presence of OXA-23 carbapenermase and class Ⅰ integrons are correlated with Acinetobacter baumannii resistant to carbapenems and multi-drug resistance.     

Risk factors and clinical responses of pneumonia patients with colistin-resistant Acinetobacter baumannii-calcoaceticus

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.     

肺炎克雷伯菌药敏分析及其超广谱β内酰胺酶基因分型研究

目的 对北京大学人民医院分离的肺炎克雷伯菌进行药敏分析及ESBL型别测定,为控制院内肺炎克雷伯菌感染提供依据.方法 收集北京大学人民医院2001-2007年分离的1 205株肺炎克雷伯菌,采用Vitek-2全自动药敏鉴定分析仪对菌株进行鉴定及药敏试验,采用WHONET 5.3软件进行药敏结果分析,PCR法检测ESBL基因型别,比较分析各种药物敏感率和基因型比率特征和差异.结果 2001-2007年肺炎克雷伯菌中产ESBL比例逐年增加:2001年为15.8% (40/253),2002年为20.9% (53/253),2003年为32.8% (42/128),2004年为32.8% (45/137),2005年为36.6% (60/164),2006年为45.3% (68/150),2007年为45.6% (73/160).ESBL阳性菌株中SHV基因检出比例最大,2007年为83.6%(61/73).ESBL阳性菌株中CTX-M基因检出率逐年增加,2007年为54.8%(40/73).携带单一SHV基因菌株与同时携带SHV、CTX-M基因菌株对头孢他啶、头孢曲松及头孢噻肟的耐药率差异有统计学意义(χ2值分别为20.26、32.03、29.65,P均＜0.05);携带单一SHV基因菌株与同时携带SHV、TEM基因菌株对头孢他啶、头孢曲松及头孢噻肟的耐药率差异有统计学意义 (χ2值分别为7.01、9.93、11.01,P均＜0.05);携带单一SHV基因菌株与同时携带SHV、OXA基因菌株对头孢他啶、头孢曲松及头孢噻肟的耐药率有统计学差异 (χ2值分别为14.11、17.58、11.54,P均＜0.05);携带CTX-M基因菌株与同时携带SHV、CTX-M基因菌株对头孢他啶耐药率差异有统计学意义(χ2=23.61,P＜0.05);携带TEM基因菌株与同时携带SHV、TEM基因菌株对头孢他啶耐药率差异有统计学意义(P=0.01).结论 肺炎克雷伯菌产ESBL逐年增加,以SHV型为主,携带CTX-M型ESBL基因菌株逐年增多.

Abstract：

Objective To analyze the antibiotic susceptibility, ESBL genotype of clinical Klebsiella pneumoniae strains isolated from People′s hospital and facilitate the control of resistance spread. Methods Identification and antibiotic susceptibility tests of 1 205 strains from 2001 to 2007 were done by VITEK-2 system.The antibiotic susceptibility results were analyzed by whonet5.3.The ESBL gene was detected by PCR and the Chi-square test was used for statistical analysis.Results The rate of ESBL-producing strains in klebsiella pneumoniae has increased from 2001 to 2007[18.8% (40/213) in 2001, 20.9% (53/253) in 2002, 32.8% (42/128) in 2003, 33.6% (45/137) in 2004, 36.6% (60/164) in 2005, 45.3% (68/150) in 2006 and 45.6% (73/160) in 2007].The SHV gene was the most dominant in ESBL genotypes.There were 83.3% (50/60) ESBL strains in 2005 with SHV gene, 82.3%(56/68) in 2006 and 83.6%(61/73) in 2007.The rated of strains with CTX-M gene were increasing.There were 26.7%(16/60) ESBL strains with CTX-M gene in 2005, 36.7%(25/68) in 2006 and 54.8%(40/73) in 2007.The isolates with more than one type of ESBL gene were increasing.There were 45%(27/60) ESBL strains in 2005 with two types of ESBL gene, and no one had more than two types of ESBL gene in that year.There were 47.9%(35/73) ESBL strains in 2007 with two types of ESBL gene.In 2007 there were 9.6%(7/73) and 2.7%(2/73) ESBL strains with three types and four types of ESBL gene respectively.There was a statistical difference between the antibiotic resistance rates of cefotaxime, ceftriaxone and ceftazidime in SHV-gene-phore strains (χ2=13.22, P＜0.01).The strains with SHV gene were more resistant to cefotaxime than ceftriaxone and ceftazidime.There also was a statistical difference of the antibiotic resistance rate of cefotaxime, ceftriaxone and ceftazidime between strains with TEM gene (χ2=9.91, P＜0.01) and CTX-M gene (χ2=34.84, P＜0.01) respectively.None of the strains with CTX-M gene was sensitive to cefotaxime, and they were more resistant to ceftriaxone than ceftazidime.The strains with TEM gene were more resistant to cefotaxime than ceftriaxone and ceftazidime.There were statistical differences of the antibiotic resistance rate to cefotaxime (χ2=29.65, P＜0.01), ceftriaxone (χ2=20.26, P＜0.01) and ceftazidime (χ2=20.26, P＜0.01) between the strains with SHV gene only and strains with SHV and CTX-M gene concurrently.There were also statistical differences of the antibiotic resistance rates to cefotaxime (χ2=11.01, P＜0.01), ceftriaxone (χ2=9.93, P＜0.01) and ceftazidime (χ2=7.01, P＜0.01) between the strains with SHV gene only and strains with SHV and TEM gene concurrently.The antibiotic resistance rates to cefotaxime (χ2=11.54, P＜0.01), ceftriaxone (χ2=17.58, P＜0.01) and ceftazidime (χ2=14.11, P＜0.01) were statistically different between the strains with SHV gene only and strains with SHV and OXA gene concurrently.The antibiotic resistance rates to ceftazidime (χ2=23.61, P＜0.01) were statistically different between the strains with CTX-M gene only and strains with SHV and CTX-M gene concurrently. There was no statistical difference in antibiotic resistance rates to cefotaxime (χ2=3.55, P＜0.01) and ceftriaxone (χ2=3.35, P＜0.01) between the strains with CTX-M gene only and strains with SHV and CTX-M gene concurrently. The antibiotic resistance rates to ceftazidime (P=0.01) were statistically different between the strains with only TEM gene and strains with SHV and TEM gene concurrently, and there was no statistical difference of the antibiotic resistance rates to cefotaxime (P=0.29) and ceftriaxone (P=0.26) between the strains with TEM gene only and strains with SHV and TEM gene concurrently. ConclusionsThe producing rate of ESBL is increasing year after year and the SHV type of ESBL is the dominant one.Strains with more than one type of ESBL gene are increasing.The antibiotic resistance rates to cefotaxime, ceftriaxone and ceftazidime are statistically different between strains with same ESBL genotype.     

多重耐药不动杆菌16S rRNA甲基化酶和同源性研究

Objective To characterize 16S rRNA methylase encoding genes associated with aminoglycoaides resistance, gene cassettes of class Ⅰ integrons of the multidrug-resistant Acinetobctcter spp. The sixty one Acinetobacter isolates were collected at the Second Hospital of Shanxi Medical Uni versity from July, 2007 to May, 2008. Methods Species identification was confirmed by sequence analysis of the blaOXA-51-like gene and 16S-23S rRNA gene space-region. Antimierobial susceptibility tests were performed by agar dilution method. 16S rRNA methylaae encoding genes and gene cassettes associated with integrons were amplified by PCR method. Results Among the sixty one strains, there were fifty five of Acinetobacter baumannii, three genospecies 3TU, one 13TU, one Aeinetobaeter ealcoacetieus, and one Aeinetobaeter haemolytieus. Forty eight isolates showed high-level resistance to three aminoglyeosides, including amikaein, tobramyein and gentamicin. The armA gene was found in 47 isolates and all isolates were negative for rmtA, rmtB, rmtC and rmtD genes. The Intl gene was found in 27 isolates. The gene cassettes contained arr-3, accA4,ctacCI ,catB8, aadA1 or dfrA12 genes. According to the PFGE DNA patterns, 5 distinct clones of armA-pasitive strains were identified. Clone A and Clone B were the dominant clones, widely distributed among different divisions. Condnsions 16S rRNA methylase encoding gene (armA) distributed widely in muhidrug-resistant Acinetobacter spp. The armA gene is not located in class Ⅰintegron. The class Ⅰ integron carries multiple resistant genes associated with aminoglycosides and chloramphenieol resistance.PFGE analysis suggests that armA-pesitive strains are widely spread in our hospitaL Effective infection control measure should be conducted in order to control the outbreak of resistant bacteria.     

多重耐药不动杆菌16S rRNA甲基化酶和同源性研究

Objective To characterize 16S rRNA methylase encoding genes associated with aminoglycoaides resistance, gene cassettes of class Ⅰ integrons of the multidrug-resistant Acinetobctcter spp. The sixty one Acinetobacter isolates were collected at the Second Hospital of Shanxi Medical Uni versity from July, 2007 to May, 2008. Methods Species identification was confirmed by sequence analysis of the blaOXA-51-like gene and 16S-23S rRNA gene space-region. Antimierobial susceptibility tests were performed by agar dilution method. 16S rRNA methylaae encoding genes and gene cassettes associated with integrons were amplified by PCR method. Results Among the sixty one strains, there were fifty five of Acinetobacter baumannii, three genospecies 3TU, one 13TU, one Aeinetobaeter ealcoacetieus, and one Aeinetobaeter haemolytieus. Forty eight isolates showed high-level resistance to three aminoglyeosides, including amikaein, tobramyein and gentamicin. The armA gene was found in 47 isolates and all isolates were negative for rmtA, rmtB, rmtC and rmtD genes. The Intl gene was found in 27 isolates. The gene cassettes contained arr-3, accA4,ctacCI ,catB8, aadA1 or dfrA12 genes. According to the PFGE DNA patterns, 5 distinct clones of armA-pasitive strains were identified. Clone A and Clone B were the dominant clones, widely distributed among different divisions. Condnsions 16S rRNA methylase encoding gene (armA) distributed widely in muhidrug-resistant Acinetobacter spp. The armA gene is not located in class Ⅰintegron. The class Ⅰ integron carries multiple resistant genes associated with aminoglycosides and chloramphenieol resistance.PFGE analysis suggests that armA-pesitive strains are widely spread in our hospitaL Effective infection control measure should be conducted in order to control the outbreak of resistant bacteria.     

临床常见革兰阴性杆菌对替加环素的药敏情况分析

目的 了解临床常见革兰阴性杆菌对替加环素的耐药情况。方法 收集2012年9月～10月浙江省9个城市15家医院的393株鲍曼不动杆菌复合群以及2012年1月～12月浙江大学医学院附属第二医院的115株大肠埃希菌,110株肺炎克雷伯菌和99株鲍曼不动杆菌复合群。用Vitek-2 Compact全自动微生物鉴定仪对细菌做鉴定及药物敏感性试验。393株分离自全省的鲍曼不动杆菌复合群用基质辅助激光解析/电离飞行时间质谱仪(matrix-assisted laser desorption/ionization time of flight mass spectrometr,MALDI-TOF MS)进行鉴定。另外挑取393株鲍曼不动杆菌复合群中GN-AST16药敏卡MIC值≥8 μg/ml或4 μg/ml的所有菌株以及少部分MIC值在≤0.5 μg/ml～2 μg/ml之间的不动杆菌159株,这些菌株同时采用Etest法和GN-AST16药敏卡对替加环素的药敏情况进行比较。结果 393株鲍曼不动杆菌复合群经MALDI-TOF MS鉴定为317株鲍曼不动杆菌,32株皮氏不动杆菌和44株医院不动杆菌。采用FDA标准,115株大肠埃希菌对替加环素的耐药率为0.0%; 110株肺炎克雷伯菌对替加环素的耐药率为7.3%; 99株鲍曼不动杆菌复合群对替加环素的耐药率为6.1%。替加环素耐药革兰阴性杆菌中,85.7%(12/14)对碳青霉烯类耐药; 而碳青霉烯类耐药革兰阴性杆菌中,仅10.0%(12/120)对替加环素耐药。结论 替加环素对临床常见的多重耐药甚至泛耐药革兰阴性杆菌有较好的抗菌活性。不管采用FDA还是EUCAST判读标准,Etest方法的耐药率比GN-AST16药敏卡方法稍低。     

373株不动杆菌的药物敏感性试验

目的了解我院临床分离不动杆菌属对15种抗菌药物的耐药性,为耐药菌感染的抗菌药物选择提供依据。方法收集我院2005年7月至2006年6月所有不动杆菌临床分离株,采用琼脂稀释法测定15种抗菌药物对该菌的最低抑菌浓度。结果本研究共包括373株不动杆菌,其中鲍曼不动杆菌352株,洛菲不动杆菌21株。药敏结果显示,鲍曼不动杆菌对多黏菌素B最为敏感,细菌耐药率仅为2.6%;其次对头孢哌酮-舒巴坦、美罗培南和亚胺培南,耐药率约为15%;对左氧氟沙星、哌拉西林-三唑巴坦、头孢吡肟、氨苄西林-舒巴坦和哌拉西林的耐药率为37.5%~59.9%;对环丙沙星、阿米卡星、头孢噻肟、头孢他啶、复方磺胺甲噁唑和庆大霉素的耐药率均大于60%。与鲍曼不动杆菌相比,除多黏菌素B外,洛菲不动杆菌对上述药物的耐药率明显较低,对多数抗菌药物的耐药率在30%以下。结论不动杆菌属是医院感染的重要病原菌,耐药率高,部分菌株呈多重耐药,治疗用药应参考药敏试验结果。     

2013～2015年临床分离的鲍曼不动杆菌的分布及耐药性分析

目的：了解该院临床分离的鲍曼不动杆菌的分布特点及对临床常用抗菌药物耐药率的变化,为临床合理用药、院内感染控制提供依据。方法应用珠海迪尔体外细菌检测专用系统进行细菌鉴定和药敏试验,用WHONET 5．6软件进行数据分析。结果院内3年间分离的鲍曼不动杆菌主来源于痰液（82．98％～88．76％）。2015年分离的70株鲍曼不动杆菌对亚胺培南等17种抗菌药物的耐药率（5．7％～41．4％）低于2014年分离的94株鲍曼不动杆菌对亚胺培南等17种抗菌药物的耐药率（6．4％～47．9％） ,而高于2013年分离的89株鲍曼不动杆菌对亚胺培南等17种抗菌药物的耐药率（2．2％～18．0％）。鲍曼不动杆菌对米诺环素、多粘菌素B、头孢哌酮／舒巴坦、亚胺培南的总耐药率较低,分别为4．7％、5．1％、10．3％、15．4％;对四环素、氨苄西林／舒巴坦、哌拉西林、环丙沙星的总耐药率较高,分别为34．4％、31．2％、31．2％、29．3％。结论鲍曼不动杆菌主要引起呼吸道感染,本院临床分离的鲍曼不动杆菌对多数常用抗菌药物的耐药率均低于文献报道。加强耐药性监测,依据药敏试验结果合理使用抗菌药物,做好消毒隔离工作,可预防和减少院内多重耐药鲍曼不动杆菌的产生和传播。     

鲍曼不动杆菌感染分布及耐药性分析

目的了解鲍曼不动杆菌的感染分布及其耐药性变化。方法对达州市中心医院2007年1月至2009年12月从临床患者标本中分离的377株鲍曼不动杆菌进行耐药性分析,并用WHONET软件进行数据处理。结果分离的鲍曼不动杆菌主要分布在重症监护病房(ICU)(38.5%),痰标本中分离的鲍曼不动杆菌最多见(74.3%)。鲍曼不动杆菌除对亚胺培南和多黏菌素敏感率较高外,对临床常用的头孢3代和氟喹诺酮类抗菌药物的耐药率大于55.0%。ICU分离株耐药率明显高于普通病房。结论鲍曼不动杆菌对多种抗菌药物耐药,且以ICU分离株最为明显,应加强细菌耐药性监测,合理使用抗菌药物,有效预防和控制感染。     

2007-2009年鲍曼不动杆菌的耐药性分析

目的探讨2007年1月至2009年6月浙江省乐清市人民医院检出的鲍曼不动杆菌(AB)对常用抗生素的耐药性变化趋势,以指导临床合理选用抗生素。方法对该院2007年1月至2009年6月分离的非重复的革兰阴性杆菌使用法国生物梅里埃公司ATB细菌鉴定仪鉴定菌种,并做药敏试验,以明确AB对常用抗菌药物的体外耐药情况。结果 220株AB中85株来自重症监护病房(ICU),85%分离自痰标本。哌拉西林的耐药率从19.5%上升至66.7%。头孢噻肟、头孢他啶和头孢吡肟的耐药率从10%左右上升到60%以上。头孢呋辛的耐药率2008年达到97.7%。亚胺培南的耐药率从5.2%上升至56.1%。氨基糖苷类和喹诺酮类的耐药率均增高。从ICU分离到的AB比非ICU的AB的耐药率普遍高30%以上。结论 AB对多种抗菌药物耐药性迅速上升。应改善医疗环境条件,增强医务人员无菌观念,合理使用抗菌药物,加强对该菌耐药性的监测,以延缓耐药菌株上升,预防和控制病区内AB流行。     

我院鲍曼不动杆菌的耐药情况分析及对策

目的了解临床分离的鲍曼不动杆菌的耐药性,为各科室抗感染治疗及合理使用抗菌药物提供依据。方法采用常规细菌培养方法从临床各种送检标本中分离出细菌,以Micro-Scan Walkaway 40微生物分析仪鉴定菌种并进行体外药物敏感(药敏)试验,在上述方法分离的鲍曼不动杆菌对14种抗菌药物全部耐药时,再使用K-B法测定鲍曼不动杆菌对头孢哌酮-舒巴坦钠的耐药情况。结果 2010年1月～2011年5月我院共分离出鲍曼不动杆菌479株,占分离细菌总数的13.8%。鲍曼不动杆菌主要分布在急诊科、呼吸内科和重症监护病房等,除头孢哌酮-舒巴坦钠外,鲍曼不动杆菌对14种抗菌药物的耐药率重症监护病房为89.0%～97.1%,胸外科为84.2%,急诊科为59.6%～97.9%,呼吸内科为66.4%～93.5%,神经内科为56.7%～73.0%,心内科为13.3%～20.0%。结论鲍曼不动杆菌对头孢哌酮-舒巴坦钠体外药敏活性强,头孢哌酮-舒巴坦钠可作为多药耐药鲍曼不动杆菌感染的首选药物。临床应加强药敏监测,并建立切实有效的感染控制措施,阻断多药耐药菌传播。     

多重耐药鲍曼不动杆菌对氨基糖苷类药物耐药性及其耐药基因(ant)的研究

目的了解多重耐药鲍曼不动杆菌对氨基糖苷类药物修饰酶的耐药性及其耐药基因。方法用琼脂稀释法检测庆大霉素、阿米卡星、链霉素、卡那霉素、妥布霉素、奈替米星、新霉素7种药物对20株多重耐药性鲍曼不动杆菌的最低抑菌浓度（MIC）；用PCR法检测两种氨基糖苷类药物核苷转移酶基因，并使用DNA测序加以证实。结果庆大霉素、阿米卡星、链霉素、卡那霉素对20株鲍曼不动杆菌的MIC50和MIC90均大于1024mg／L，耐药率分别为95％、95％、100％和90％；而妥布霉素、奈替米星和新霉素的耐药率分别为85％、90％、40％。从20株菌中检出ant（2”）-I、ant（3”）-I两种修饰酶基因，阳性率分别为55％、80％，10株细菌两种基因同时阳性，占50％。结论鲍曼不动杆菌对氨基糖苷类药物耐药与ant（2”）-I、ant（3”）-I基因有非常密切的关系。     

1685株鲍曼不动杆菌的临床分布及耐药性研究

目的探讨川北医学院附属医院鲍曼不动杆菌感染的临床分布和耐药特点,为该菌的感染治疗与预防提供依据。方法该院2011~2014年住院患者送检标本中分离的1 685株鲍曼不动杆菌的分布及耐药性检测。结果鲍曼不动杆菌主要分离自痰液标本,占73.1%;以重症监护病房和神经外科病房检出率最高;该菌仅对头孢哌酮/舒巴坦和米诺环素耐药率低,分别为27.9%和26.9%;对亚胺培南、美罗培南的耐药率分别为77.4%、73.9%;对其余多种抗菌药物耐药率在62.0%以上。结论鲍曼不动杆菌的耐药率较高并具有多重耐药性,临床治疗应及时进行细菌耐药性监测并根据药敏试验结果选择合适的抗菌药物。