吴江地区多重耐药鲍曼不动杆菌碳青霉烯酶基因携带情况及同源性

目的了解吴江地区临床分离多重耐药鲍曼不动杆菌(MDRAB)碳青霉烯酶基因携带情况和同源性。方法收集吴江地区3所综合性医院2010年1月—2013年12月临床分离的非重复MDRAB 44株，测定其最低抑菌浓度(MIC)；采用聚合酶链反应（PCR）扩增碳青霉烯酶基因OXA 51、OXA 23、OXA 24、OXA 58、IMP、TEM、SHV和GES，脉冲场凝胶电泳(PFGE)分析菌株同源性。结果44株MDRAB主要来源标本为痰（占93.18%），主要分布在重症监护病房（ICU）、呼吸科和神经外科，各占45.45%、27.27%和13.64%；MDRAB对米诺环素和多粘菌素B均敏感，对哌拉西林、氨苄西林/舒巴坦、头孢他啶、庆大霉素、阿米卡星、环丙沙星耐药率均为100.00%，对亚胺培南和美罗培南耐药率均为97.73%。44株MDRAB均检出OXA 51、OXA 23和TEM基因，其中12株菌GES基因阳性，OXA 58和SHV基因阳性各1株，未检测到OXA 24及IMP基因；MDRAB分为A—G 7个型别，分别为19、3、9、3、1、4、5株。A型主要来源于吴江地区的两所大型综合性医院（吴江第一人民医院和盛泽医院），吴江第一人民医院未发现B、D和E型；E型仅1株，分布在永鼎医院，其余型别散在分布。结论吴江地区临床分离鲍曼不动杆菌多重耐药严重，基因OXA 23和TEM是鲍曼不动杆菌多重耐药的主要原因，并以A、C型为主，呈克隆性传播。

Carriage and homology of carbapenemase genes of multidrug resistant Acinetobacter baumannii in Wujiang

ObjectiveTo investigate the carriage and homology of carbapenemase genes of multidrug resistant Acinetobacter baumannii (MDRAB) in Wujiang area.MethodsA total of 44 non duplicated MDRAB isolated from patients in 3 general hospitals in Wujiang area from January 2010 to December 2013 were collected. Minimum inhibitory concentrations(MICs) were detected, carbapenemase genes OXA 51, OXA 23, OXA 24, OXA 58, IMP, TEM, SHV, and GES were amplified with polymerase chain reaction(PCR), homology of strains was detected with pulsed field gel electrophoresis(PFGE).Results44 MDRAB strains were mainly collected from sputum (93.18%), mainly distributed in intensive care unit (ICU), department of respiratory diseases, and department of neurosurgery, accounting for 45.45%, 27.27%, and 13.64% respectively; MDRAB were both sensitive to minocycline and polymyxin B, resistance rates to piperacillin, ampicillin/sulbactam, ceftazidime, gentamicin, amikacin, and ciprofloxacin were all 100.00%, resistance rates to imipenem and meropenem were both 97.73%. 44 MDRAB strains were all detected OXA 51, OXA 23 and TEM genes, 12 strains were positive for GES gene, 1 strain was positive for OXA 58 and SHV respectively, OXA 24 and IMP genes were not found ; MDRAB were divided into 7 types of G A, which included 19, 3, 9, 3, 1, 4, and 5 strains respectively, type A was mainly from two large general hospitals in Wujiang area (Wujiang First People’s Hospital and Shengze Hospital), type B, D and E strains were not detected in Wujiang First People’s Hospital, type E strain was only 1 isolate and was from Yongding Hospital, the other types were sporadically distributed.ConclusionMultidrug resistance of clinically isolated Acinetobacter baumannii is serious in Wujiang area, OXA 23 and TEM genes are major causes of multidrug resistance in Acinetobacter baumannii, the main types are A and C, which present clonal spread.