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目的了解南京市某医院鲍曼不动杆菌的感染和耐药情况。方法对2011年2月至2013年4月临床检出的56例鲍曼不动杆菌标本进行药敏试验;采用聚合酶链式反应(PCR)进行OXA-51、OXA-23、OXA-24、OXA-58、VIM、SHV、GES、IMP和TEM共9种耐药基因的检测;从中选择44株应用脉冲场凝胶电泳(PFGE)进行同源性分析。结果 56株检出泛耐药株38株,不同病区泛耐药与非泛耐药株的阳性率差异有统计学意义。菌株对常用抗生素除阿米卡星和妥布霉素外,耐药率均大于60.00%。56株经PCR检出OXA-51 49例(87.50%)、OXA-23 46例(82.14%)、OXA-58 1例(1.79%)、TEM 56例(100.00%)、VIM 45例(80.36%)、GES 16例(28.57%)及SHV 4例(7.14%);未检出OXA-24和IMP。44株经PFGE共分为14个型,其中A型20株,为主要流行株;B型5株,C型8株,剩余菌株为互不相同型。结论该院鲍曼不动杆菌感染以ICU和呼吸科居多,对常用抗生素高度耐药,OXA-51,OXA-23,TEM和VIM为主要耐药基因。近半数菌株以同源形式传播,交叉感染现象严重,应引起重视和采取改进措施。
Objective To understand the infection and drug resistance of Acinetobacter baumannii in a hospital in Nanjing. Methods 56 samples of Acinetobacter baumannii clinically detected from February 2011 to April 2013 were tested for susceptibility. OXA-51, OXA-23, OXA-24 and OXA-24 were detected by polymerase chain reaction OXA-58, VIM, SHV, GES, IMP and TEM. Forty-four strains were selected for their homology analysis by pulsed-field gel electrophoresis (PFGE). Results Fifty-eight strains of pan-resistant strains were detected in 56 strains. There was significant difference in the positive rates of pan-resistant and non-pan-resistant strains in different wards. The strains of commonly used antibiotics except amikacin and tobramycin, the resistance rates were greater than 60.00%. Fifty-six (82.14%) of OXA-23, one of OXA-58 (1.79%), 56 of 56 TEM (100.00%) and 45 of VIM (80.36% ), 16 cases (28.57%) of GES and 4 cases (7.14%) of SHV. OXA-24 and IMP were not detected. Forty-four strains were divided into 14 types by PFGE, of which 20 strains were type A and 5 were type B and 8 were type C, respectively. The remaining strains were different from each other. Conclusion Acinetobacter baumannii infection is mainly in the ICU and respiratory department. It is highly resistant to commonly used antibiotics. OXA-51, OXA-23, TEM and VIM are the major resistance genes. Nearly half of the strains spread homologous form, cross-infection is serious, should pay attention to and take improvement measures.