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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 162 -167. doi: 10.3877/cma.j.issn.1674-1358.2017.02.012

临床论著

某院院内耐碳青霉烯鲍曼不动杆菌分子流行病学研究
吴海燕1, 谭斌2, 张志军3, 姜梅杰3,†()   
  1. 1. 271000　泰安市，山东省泰安市中心医院ICU
    2. 271000　泰安市，山东省泰安市中心医院输血科
    3. 271000　泰安市，山东省泰安市中心医院检验科
  • 收稿日期:2016-12-18 出版日期:2017-04-15
  • 通信作者: 姜梅杰
  • 基金资助:
    山东省自然科学基金(No. ZR2013MH009)

Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from a hospital

Haiyan Wu1, Bin Tan2, Zhijun Zhang3, Meijie Jiang3,†()   

  1. 1. Intensive Care Unit, Central Hospital of Taian, Taian 271000, China
    2. Department of Blood Transfusion, Central Hospital of Taian, Taian 271000, China
    3. Department of Clinical Laboratory, Central Hospital of Taian, Taian 271000, China
  • Received:2016-12-18 Published:2017-04-15
  • Corresponding author: Meijie Jiang
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引用本文：

吴海燕, 谭斌, 张志军, 姜梅杰. 某院院内耐碳青霉烯鲍曼不动杆菌分子流行病学研究[J]. 中华实验和临床感染病杂志(电子版), 2017, 11(02): 162-167.

Haiyan Wu, Bin Tan, Zhijun Zhang, Meijie Jiang. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from a hospital[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(02): 162-167.

目的

研究本院某段时间分离的耐碳青霉烯鲍曼不动杆菌（CRAB）的分子流行病学特征，为医院感染的防控提供依据。

方法

对2015年10月至2016年2月本院临床分离的55株CRAB，采用多位点序列分型（MLST）分析菌株之间的克隆关系。采用PCR法筛选碳青霉烯酶基因和消毒剂基因qacE△1。

结果

55株CRAB共检出6种已报道的STs，依次为ST208（38.2%）、ST369（25.5%）、ST195（20%）、ST451（10.9%）、ST195（3.6%）和ST381（1.8%）。碳青霉烯酶基因OXA-51和OXA-23均为阳性，96.4%（53/55）菌株携带qacE△1基因。90%以上样本分离自本院各重症监护病房患者的痰液。

结论

本院该时间段分离的CRAB发生过克隆株流行，产OXA-23 ST208、ST369和ST195型CRAB为本院主要的流行克隆株。

关键词: 耐碳青霉烯, 鲍曼不动杆菌, 多位点序列分型, 碳青霉烯酶耐药基因, 消毒剂耐药基因
Objective

To investigate the molecular epidemiological characteristics of carbapenem-resistant Acinetobacter baumannii (CRAB) isolated from our hospital at a certain time, and to provide the basis for the prevention and control of nosocomial infections.

Methods

Total of 55 stains of CRAB were isolated from the hospital from October 2015 to February 2016. Cloning relationship were conducted by multi-site sequence typing (MLST). The screening of carbapenemase gene and disinfectant gene (qacEΔ1) were detected by PCR.

Results

Six kinds of STs were detected by MLST, which were ST208 (38.2%), ST369 (25.5%), ST195 (20%), ST451 (10.9%), ST195 (3.6%) and ST381 (1.8%). Carbapenemase genes, such as OXA-51 and OXA-23 were both positive, and 96.4% (53/55) of the stains carried qacEΔ1 gene. More than 90% of the specimens were isolated from sputum separated from the patients in Intensive Care Unit.

Conclusions

There was a prevalence caused by CRAB stains of clones during this period. ST208, ST369 and ST195 CRAB carrying OXA-23 gene were the main clones in our hospital.

Key words: Carbapenem-resistant, Acinetobacter baumannii, Multiple-site sequence typing, Carbapenem-resistance gene, Disinfectant-resistant gene
表1 55株CRAB对15种抗菌药物的敏感性
抗菌药物 敏感 中介 耐药
株数 敏感率（%） 株数 中介率（%） 株数 耐药率（%）
阿米卡星 1 1.8 0 0.0 54 98.2
头孢他啶 0 0.0 0 0.0 55 100.0
头孢曲松 0 0.0 0 0.0 55 100.0
环丙沙星 0 0.0 0 0.0 55 100.0
头孢吡肟 0 0.0 0 0.0 55 100.0
庆大霉素 1 1.8 0 0.0 54 98.2
亚胺培南 0 0.0 0 0.0 55 100.0
左氧氟沙星 0 0.0 0 0.0 55 100.0
美罗培南 0 0.0 0 0.0 55 100.0
复方新诺明 2 3.6 0 0.0 53 96.4
哌拉西林/他唑巴坦 0 0.0 0 0.0 55 100.0
妥布霉素 1 1.8 0 0.0 54 98.2
头孢哌酮/舒巴坦 3 5.4 15 27.3 37 67.3
替加环素 41 74.5 14 25.5 0 0.0
多黏菌素B 55 100.0 0 0.0 0 0.0
图1 OXA51基因PCR产物电泳图
图2 OXA23qc基因PCR产物电泳图
图3 qacE△1基因PCR产物电泳图
图4 OXA51基因测序图
图5 OXA23基因测序图
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