【摘要】 目的 对院内感染所分离出来的泛耐药鲍曼不动杆菌进行耐药基因检测并分析其同源性。方法 采用MIC法对2013年1月～8月分离自住院病人的鲍曼不动杆菌进行药敏筛选,取其中的34株采用PCR技术检测金属β-内酰胺酶IMP,VIM基因,超广谱β-内酰胺酶TEM,SHV与GES基因,苯唑西林水解酶(OXA)OXA-51,OXA-23,OXA-24与OXA-58基因在实验菌株中的携带情况;利用脉冲场电泳(PFGE)对临床分离株进行基因分型及同源性分析。结果 该院上半年临床所分离的泛耐药鲍曼不动杆菌主要来自于ICU、急诊病房、呼吸科和神经外科,分别占总分离率的29.40%,17.64%,14.70%与11.76%;所有耐药菌株均同时携带多种耐药基因,OXA-51,OXA-23,VIM及TEM基因在菌株中的携带率均为100%,部分携带GES基因,携带率为29.4%,少量携带OXA-58和SHV基因,未检出OXA-24和IMP基因。PFGE结果显示院内共有4个不同类型的克隆株流行,其中A类最为多见且各科室间存在交叉感染。结论 泛耐药鲍曼不动杆菌的耐药机制是多基因协同作用的结果,在院内主要以克隆形式播散传播,局部流行呈现出型别特异性,除规范临床抗生素使用以减少泛耐药鲍曼不动杆菌的产生外,切断传播途径,防止交叉感染是非常必要的。更多还原

【Abstract】 Objective To study nine types of drug resistant-related genes and analysis of homology in pandrug-resistant Acinetobacter baumannii acquired in hospital.Methods Pandrug-resistant Acinetobacter baumannii were identified by MIC,then drug resistant-related genes including OXA-51,OXA-23,OXA-24,OXA-58,IMP,VIM,TEM,SHV and GES were detected,by PCR,pulse-field gel electrophoresis(PFGE) technology were performed to analysis the homology of these strains.Results There was highly morbidity of pandrug-resistant Acinetobacter baumannii infections in hospital,especially in ICU,emergency ward,respiratory ward and neurosurgery ward,occupying respectively of the rate of 29.40%,17.64%,14.70%and11.76%.All of the pandrug-resistant isolates had been proven to carry a variety of drug-resistant genes,OXA-51,OXA-23,VIM and TEM were carried in all isolates but not of OXA-24 and IMP,some isolates,were found to carry GES,SHV and OXA-58.All the strains were classified into 4 unrelated groups and 8 patterns by PFGE and group A should be the major epidemic strains causing nosocomial infection.Conclusion Pandrug-resistant Acinetobacter baumannii were often gathered in those wards where patients with compromised immunity and long-term medication or had a intervention operations revently.The mechanism of pandrug-resistance is mediated by multiple genes,clone dissemination plays an important role in pandrugresistant Acinetobacter baumannii infections.In addition to standardize the clinical use of antibiotics to reduce the generation of pandrug-resistant Acinetobacter baumannii,it is necessary to isolate those patients at high risk of infection and strengthen the concept of sterility and hand hygiene for cutting off the transmission and preventing cross-infection.更多还原