【摘要】 目的探讨鲍曼不动杆菌(Acinetobacter baumannii,A.baumannii)耐药性及碳青霉烯酶相关耐药基因OXA-23、OXA-24、OXA-51和OXA-58的分布情况,为临床抗菌药物的合理选择提供依据。方法 2014年1至月2014年12月收集佳木斯大学附属第一医院临床标本(包括痰、分泌物、脑脊液、血液、咽拭子等标本),使用VITEK-II全自动微生物鉴定/药敏测试系统筛选出44株A.baumannii;采用多重PCR检测A.baumannii携带的碳青霉烯酶相关耐药基因OXA-23、OXA-24、OXA-51、OXA-58,并对耐药基因扩增的阳性产物进行DNA序列分析。结果 44株A.baumannii对复方新诺明、亚胺培南、左氧氟沙星的敏感率分别为65.91%、61.36%、61.36%,对其他抗菌药物的敏感率均低于50.00%。4种耐药基因的检测结果为:44株(100.00%)携带OXA-51基因,20株(45.45%)携带OXA-23基因,14株(31.82%)携带OXA-24基因,3株(6.82%)携带OXA-58基因。16株碳青霉烯类药物耐药A.baumannii中,14株(87.50%)携带OXA-23,1株(6.25%)携带OXA-58,8株(50.00%)携带OXA-24,5株(31.25%)同时携带OXA-23、OXA-24。DNA序列分析结果显示:OXA-23、OXA-24、OXA-51、OXA-58分别与NCBI的序列同源性均为99.00%。结论A.baumannii耐药性强,OXA-23型基因可能是A.baumannii对碳青霉烯酶类抗菌药物耐药的主要原因,我院发现我国少见OXA-24基因或许为区域性流行,携带多种耐药基因是导致A.baumannii对多种常用抗菌药物耐药的重要原因。更多还原

【Abstract】 Objective To learn the distribution of the resistance and carbapenemase-related genes( OXA-23,OXA-24,OXA-51 and OXA-58) of Acinetobacter baumannii( A. baumannii) and provide basis for reasonable selection of antimicrobial drugs. Methods Clinical specimens from January 2014 to December 2014 were collected in the First Affiliated Hospital of Jiamusi University. VITEK-II automated system was used to screen A. baumannii.Multiplex PCR detection method was used to identify OXA-23,OXA-24,OXA-51 and OXA-58 genes,and resistance genes in the positive amplified products were subjected to DNA sequence analysis. Results 44 strains of A.baumannii were identified. Their susceptibility rates to co-trimoxazole,imipenem and levofloxacin were 65. 91%,61. 36% and 61. 36% respectively,while the susceptibility rates to other antimicrobial agents were lower than50. 00%. The detection of resistant genes found 44 strains( 100. 00%) carrying OXA-51 gene,20( 45. 45%)carrying OXA-23 gene,14( 31. 82%) carrying OXA-24 gene and 3( 6. 82%) carrying OXA-58 gene. Among the16 carbapenem resistant strains,14( 87. 50%) carried OXA-23 gene,1( 6. 25%) carried OXA-58 gene,8( 50. 00%) carried OXA-24 gene and 5( 31. 25%) carried both OXA-23 and OXA-24 genes. DNA sequence analysis of OXA-23,OXA-24,OXA-51 and OXA-58 showed a 99. 00% homology with the NCBI sequences between OXA-23 and OXA-51 as well as between OXA-24 and OXA-58. Conclusion A. baumannii has strong resistance against antimicrobial agents and OXA-23 gene may be the main reason of A. baumannii’ s carbapenemase resistance. The rare OXA-24 gene found in our hospital might probably be due to the regional distribution of various strains of A. baumannii. The main reason of its resistance to a variety of commonly used antimicrobial agents is the presence of multiple drug resistant genes in A. baumannii.更多还原