文章摘要
王 政,刘 丁,陈 萍,程晓斌,王 豪,成 瑶.重症监护室产OXA-23碳青霉烯类酶的鲍曼不动杆菌的分子流行病学研究[J].南京医科大学学报,2011,(9):1316~1324
重症监护室产OXA-23碳青霉烯类酶的鲍曼不动杆菌的分子流行病学研究
Molecular epidemiology character of carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in intensive care unit
投稿时间:2011-04-20  
DOI:10.7655
中文关键词: 鲍曼不动杆菌  OXA-23碳青霉烯酶  脉冲场电泳  医院感染  重症监护室  分子流行病学
英文关键词: Acinetobacter baumannii  OXA-23 carbapenemase  pulsed field gel electrophoresis  nosocomial infection  intensive care unit  molecular epidemiology
基金项目:
作者单位
王 政 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
刘 丁 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
陈 萍 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
程晓斌 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
王 豪 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
成 瑶 第三军医大学附属大坪医院野战外科研究所,重庆市医院感染控制中心, 重庆 400042 
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中文摘要:
      目的:研究重症监护病房中耐碳青霉烯类鲍曼不动杆菌的分子流行病学特征,为临床预防和控制医院感染暴发提供分子流行病学依据?方法:本研究收集了重症监护病房自2006年10月~2010年1月,从患者分离的40株耐碳青霉烯类的鲍曼不动杆菌,琼脂稀释法测定14种抗菌药物的最小抑菌浓度,设计通用引物多重PCR扩增D类碳青霉烯酶基因blaOXA-23?blaOXA-24?blaOXA-51?blaOXA-58并测序?EDTA纸片法检测金属酶表型,PCR检测基因型blaIMP?blaVIM?blaSIM,脉冲凝胶电泳分析其同源性?结果:所有耐碳青霉烯类的鲍曼不动杆菌对阿米卡星?庆大霉素和左氧氟沙星等保持有一定敏感性,但对其余抗菌药物耐药率均为100%?所有耐碳青霉烯类的鲍曼不动杆菌均产OXA-23型碳青霉烯酶,在blaOXA-23上游连接有ISAba1启动元件,未检测到blaOXA-24?blaOXA-58碳青霉烯酶基因;金属酶表型及基因型均为阴性?PFGE分为4种克隆型,以A?D型为主?所有耐碳青霉烯类的鲍曼不动杆菌感染患者中,34例(85.0%)为呼吸道感染,5例(12.5%)为伤口感染,1例(2.5%)为血流感染?经临床治疗后,21例(52.5%)存活,12例(30.0%)死亡,7例未出院?结论:本研究重症监护病房流行的40株耐碳青霉烯类的鲍曼不动杆菌均产OXA-23型碳青霉烯酶,以A型和D型克隆为主要流行株,随着抗菌药物选择性压力的作用,出现了全耐药菌株?
英文摘要:
      Objective:To explore the molecular epidemiology character of carbapenem-resistant Acinetobacter baumannii (CRAb) by phenotyping and genotyping methods,and provide evidence of molecular epidemiology to prevent nosocomial infection(NI). Methods: In this study,40 CRAb strains were isolated from patients of intensive care unit(ICU). Broth dilution method were used to detect patterns of resistant against 14 antimircobial agents,and multiplex PCR was performed to detected class D β-lactamase encoding genes. Phenotype of metallo-β-lactamase were detected by EDTA disk method,blaIMP,blaVIM,blaSIM amplified by PCR method. Pulsed-field gel electrophoresis(PFGE) was analyzed to find the relationship among these isolates. Results: All CRAb kept low susceptibility to amikacin, gentamicin and levofloxacin, but resistance to other agents. All CRAb producing carbapenemases were confirmed as OXA-23 by PCR and sequencing. A promoter ISAba1 was found in the upstream of OXA-23. Metallo-β-lactamase was negative in any of the isolates. They were classified into 4 clones based on PFGE pattern. Clone A and D had been spreading widely. In all 40 infection patients,34(85.0%) were respiratory tract infections,5(12.5%) were wound infection,1(2.5%) were bloodstream infections. After clinical treatment,21 (52.5%) survived,12 (30.0%) died,and 7 were not discharged. Conclusion: All CRAb caused outbreak producing OXA-23 carbapenemase,and the main genetypes included clone A and clone D. And with the role of antimicrobial drug-selective pressure,full-resistant strains have appeared.
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