血液病患者鲍曼不动杆菌的耐药性分析及其耐药基因检测

目的了解血液病患者临床分离鲍曼不动杆菌的耐药表型和多种耐药基因的携带情况。方法收集2011年临床分离的非重复鲍曼不动杆菌120株,采用纸片扩散法进行药敏试验,试验结果按照CLSI 2011年版标准判读,采用WHONET 5.6软件进行数据分析;应用聚合酶链反应及测序方法检测10种耐药相关基因（blaOXA-51-like、blaOXA-23-like、blaOXA-24-like、blaOXA-58-like、blaTEM、blaampC、armA、ISAba1、intI 1和intI 2）。结果鲍曼不动杆菌对13种抗菌药物的耐药率范围为48.3%~94.2%,对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药率分别为51.7%和48.3%;耐药相关基因blaOXA-51-like、blaOXA-23-like、blaTEM、blaampC、armA、ISAba1和intI 1的阳性率分别为100%、60.0%、46.7%、85.8%、75.8%、86.7%和85.0%,而未检出blaOXA-24-like、blaOXA-58-like和intI 2。结论碳青霉烯类抗菌药物对鲍曼不动杆菌仍具有较好的体外抗菌活性,鲍曼不动杆菌多重耐药相关基因的携带率较高,多重耐药现象非常严重,应加强其耐药性监测,合理使用抗菌药物。

Analysis of antibiotic resistance and multidrug-resistant genes in Acinetobacter baumannii isolates from leukemia patients

Objective To gain a insight into the antibiotic resistance phynotypes and the prevalent resistance genes of Acinetobacter baumannii isolates from patients with leukemia.Methods 120A.baumannii isolates were collected in 2011.All isolates were subjected to the Whonet 5.6software to analyze the susceptibility of 13antimicrobial agents according to CLSI 2011breakpoints,and to PCR to detect resistance genes of blaOXA-51-like,blaOXA-23-like,blaOXA-58-like,blaTEM,blaampC,armA,ISAba1and intI 1.Results The rates of resistance to the majority of antibiotics tested varied between 48.3%and 94.2%,with the exception of imipenem（51.7%）,and meropenem（48.3%）.This study showed a high distribution of blaOXA-51-like,blaOXA-23-like,blaampC,armA,ISAba1,blaTEM and intI 1genes,which mediate resistance to structurally unrelated antimicrobials.Conclusion Carbapenems still has good antibacterial activity against A.baumannii,but the high rates of resistance to most antibiotics in A.baumannii is a critical issue.The full-time infection control personnel and physicians should actively participate in the antimicrobial resistance surveilliance,appropriately use the antimicrobial agents,and effectively prenvent and control of infections caused by A.baumannii.