仪征地区鲍曼不动杆菌碳青霉烯类抗菌药耐药相关酶表型和基因型分析
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江苏省医学创新团队暨领军人才基金


Phenotypic and genotypic analysis of carbapenems associated with antimicrobial resistance of Acinetobacter baumannii in Yizheng area
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    摘要:

    目的:研究江苏省仪征地区鲍曼不动杆菌对碳青霉烯类药物耐药相关酶表型和基因型的分布情况,探讨该地区广泛耐药鲍曼不动杆菌对碳青霉烯类耐药的主要机制。方法:根据常规药敏试验结果将鲍曼不动杆菌临床分离株分为广泛耐药组和普通组,分别选取25株和23株用改良EDTA纸片增效法检测金属β-内酰胺酶;用碳青霉烯失活法检测碳青霉烯酶;用双纸片协同试验法和三维试验法分别检测染色体和质粒介导的AmpC酶;用PCR方法检测耐药基因blaOXA-23、blaOXA-24、blaTEM、blaAmpC、blaVIM、blaNDM-1,对部分阳性产物进行测序比对。结果:鲍曼不动杆菌广泛耐药组和普通组分别占62.5%和37.5%。广泛耐药组中金属β-内酰胺酶阳性1株、碳青霉烯酶阳性4株、染色体和质粒介导的AmpC酶阳性分别为1株和23株;普通组中均未检出上述酶表型。广泛耐药组全部检出耐药基因blaOXA-23、blaTEM、blaAmpC,均未检出blaOXA-24、blaVIM、blaNDM-1;普通组中blaOXA-23、blaOXA-24、blaTEM、blaAmpC分别检出4、5、22、12株,未检出blaVIM、blaNDM-1。两组比较,质粒介导的AmpC酶和blaOXA-23、blaAmpC基因携带率的差异具有统计学意义(χ2分别为40.627、34.183、15.511,P < 0.001)。基因测序结果发现部分菌株的序列存在碱基插入或置换的改变。结论:鲍曼不动杆菌耐药性严重,产质粒介导的AmpC酶和blaOXA-23、blaAmpC基因介导的耐药机制是仪征地区鲍曼不动杆菌广泛耐药的主要机制。

    Abstract:

    Objective:To study the phenotypic and genotypic distribution of Acinetobacter baumannii in Yizheng area to carbapenem drug resistance,and to explore the main mechanism of carbapenem resistance of Acinetobacter baumannii. Methods:The clinical isolates of Acinetobacter baumannii were divided into two groups according to the results of routine drug sensitivity test. Twenty-five strains of extensively drug-resistant Acinetobacter baumannii(XDRAb)and 23 of common strains were selected to detect metal β-lactamases by modified EDTA disk synergy method. Carbapenem was detected by carbapenem inactivation method,chromosome and plasmide-mediated AmpC enzyme were detected by double disk synergy test and modified three dimensional test,and the resistant genes blaOXA-23,blaOXA-24,blaTEM,blaAmpC,blaVIM,and blaNDM-1 were detected by PCR method,and some positive products were sequenced and compared. Results:The XDRAb group and the common group accounted for 62.5% and 37.5%,respectively. One strain of metal β-lactamase,4 strains of carbapenemase,and 1 strain of chromosome and 23 strains of plasmide-mediated AmpC enzyme were positive in the XDRAb group,but none of them were detected in the common group. The genes blaOXA-23,blaTEM,and blaAmpC were detected in all strains of XDRAb,and blaOXA-24,blaVIM,and blaNDM-1 were not detected in all of them. In the normal group,4 strains of blaOXA-23,5 strains of blaOXA-24,22 strains of blaTEM and 12 strains of blaAmpC were detected respectively,while blaVIM and blaNDM-1 were not detected in all strains. The difference of plasmid mediated AmpC enzyme,blaOXA - 23,and blaAmpC gene carrying rate between the two groups was statistically significant(χ2=40.627,34.183,15.511,P < 0.001,respectively). The results of gene sequencing showed that the sequence of some strains was changed by base insertion or replacement. Conclusion:The drug resistance of Acinetobacter baumannii to carbapenem is serious in Yizheng area. The main mechanisms of Acinetobacter baumannii resistance to carbapenem are plasmide-mediated AmpC enzyme,blaOXA-23 and blaAmpC gene mediated drug resistance.

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江培涛,方 敏,刘棵文,马 超,王晶晶,严 枫.仪征地区鲍曼不动杆菌碳青霉烯类抗菌药耐药相关酶表型和基因型分析[J].南京医科大学学报(自然科学版),2019,(1):54-61

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  • 收稿日期:2018-10-06
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  • 在线发布日期: 2019-02-21
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