耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (10): 1093-1098.

耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究

汪红, 胡龙华, 宁长秀, 杭亚平, 钟桥石, 胡晓彦, 章白苓, 贾坤如

南昌大学第二附属医院检验科,南昌 330006,江西

收稿日期:2014-03-07 修回日期:2014-08-07 出版日期:2014-10-26 发布日期:2014-10-29
通讯作者: 胡龙华,男,主任技师,硕士生导师,研究方向:临床微生物学及细菌耐药机制。 Tel: 0791-86300410 E-mail: longhuahu@163.com
作者简介:汪红,女,在读硕士研究生,研究方向:临床微生物学及细菌耐药机制。
基金资助:
江西省科技支撑计划(20112BBG70054)

Study on the mechanism of carbapenem resistance in Acinetobacter baumannii

WANG Hong, HU Long-hua, NING Chang-xiu, HANG Ya-ping, ZHONG Qiao-shi, HU Xiao-yan, ZHANG Bai-ling, JIA Kun-ru

Department of Clinical Laboratory,the Second Affiliated Hospital of Nanchang University,Nanchang 330006 , Jiangxi,China

Received:2014-03-07 Revised:2014-08-07 Online:2014-10-26 Published:2014-10-29

摘要/Abstract

摘要： 目的调查和研究南昌地区鲍曼不动杆菌对碳青霉烯类抗生素的耐药机制。方法收集南昌大学第二附属医院2012年间临床分离的耐亚胺培南鲍曼不动杆菌(CRAB)非重复株。Vitek-32型全自动微生物分析仪进行菌株鉴定,K-B法进行药敏试验,三维试验检测AmpC酶,EDTA协同试验检测金属β-内酰胺酶,采用聚合酶链反应(PCR)扩增耐药基因,并对阳性产物进行双向测序分析,确定其基因型。结果 84株CRAB对临床常用的12种抗菌药物有9种耐药率>90%,对头孢哌酮-舒巴坦的耐药率最低(44.0%),所有菌株均为多重耐药株。三维试验在83株菌(98.8%)中检出AmpC酶,协同试验未检出产金属酶菌株。所有菌株均携带blaOXA-23、blaOXA-51及blaADC基因,1株携带blaOXA-58基因,未检测到blaOXA-24及金属酶基因(blaIMP、blaVIM-2、blaNDM-1及blaSIM-1); 外排泵编码基因adeB、调控基因adeS和adeR的检出率分别为 98.8%( 83/84) 、81.0%( 68/84) 和 67.9%( 57/84);所有菌株均检出外膜蛋白carO基因;69株(82.1%)检测出I类整合酶基因(intI1),全部菌株携带插入序列ISAba1。结论南昌地区CRAB耐药性及多重耐药性非常严重,鲍曼不动杆菌对碳青霉烯类抗生素耐药的主要机制为产OXA-23型碳青霉烯酶,AmpC酶、外排泵AdeABC、I类整合子和插入序列ISAba1,可能与CRAB的多重耐药性密切相关。

关键词: 碳青霉烯类抗生素, 鲍曼不动杆菌, 耐药机制

Abstract: AIM: To investigate the mechanism of carbapenems resistance in Acinetobacter baumannii in nanchang. METHODS: Nonduplicate carbapenem- resistant A.baumannii (CRAB) isolates collected during 2012 in Second Affiliated Hospital of Nanchang University,strains were identified by vitek-32 automatic microbe analyzer, antimicrobial susceptibility testing by Kirby-Bauer method,AmpC enzyme by three dimensional test,Metallo β-lactamases(MBLs) by EDTA synergy test. Resistance genes were amplified by PCR,the positive results were sequenced to identify the genotype. RESULTS: More than 90% of 84 CRAB isolates were resistant to 9 of 12 antimicrobial agents tested,but the least resistant to cefoperazone-sulbactam(44.0%),and all the strains were multiple drug-resistant. Among the 84 isolates,AmpC enzyme in 83(98.8%) strains was detected,no MBLs-producing strain was found by synergy test. All strains had blaOXA-23, blaOXA-51 and blaADC genes and one had blaOXA-58 gene,while MBLs and blaOXA-24 genes were all negative. The positive rates of adeB,adeS and adeR genes were 98.8%(83/84), 81.0%(68/84) and 67.9%(57/84). The carO gene was found in all isolates,class I intergase gene was detected in 69 isolates,each strain carried ISAba1. CONCLUSION: The drug resistance of CRAB is very severer in nanchang. Production of OXA-23 carbapenemase in A.baumannii is major mechanism of carbapenems resistance in local area. AmpC enzyme, efflux pump AdeABC, class I integron and ISAba1 may be closely related to multidrug resistance of CRAB.

Key words: carbapenems, acinetobacter baumannii, resistance mechanism

中图分类号:

R446.5

汪红, 胡龙华, 宁长秀, 杭亚平, 钟桥石, 胡晓彦, 章白苓, 贾坤如. 耐碳青霉烯类抗生素鲍曼不动杆菌耐药机制的研究[J]. 中国临床药理学与治疗学, 2014, 19(10): 1093-1098.

WANG Hong, HU Long-hua, NING Chang-xiu, HANG Ya-ping, ZHONG Qiao-shi, HU Xiao-yan, ZHANG Bai-ling, JIA Kun-ru. Study on the mechanism of carbapenem resistance in Acinetobacter baumannii[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(10): 1093-1098.

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