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目的研究肿瘤科患者感染鲍曼不动杆菌的耐药性变化情况及耐药机制,为临床治疗及耐药性控制提供指导。方法收集2012年1月-2014年12月本院肿瘤科患者临床标本培养,挑取单菌落进行菌株鉴定;采用K-B法进行药敏试验;提取细菌DNA进行PCR扩增,检测耐药基因分布情况。结果共分离368株鲍曼不动杆菌,其中2012年108株,2013年126株,2014年134株。耐药性分析表明,鲍曼不动杆菌分离株对阿米卡星、头孢曲松、头孢他啶、头孢噻肟、头孢吡肟、环丙沙星、亚胺培南、左氧氟沙星均耐药,且耐药程度逐年增强。采用PCR扩增法检测鲍曼不动杆菌OXA-58、ant(3’)-I、OXA-23、IMP、PER、OXA-24、TEM、aac(3)-Ia、aac(6’)-Ib基因大小分别为507、284、291、587、961、496、535、337和597bp。在2012年的108株分离菌中,TEM、PER、OXA-23、OXA-24、OXA-58、IMP、aac(3)-Ia、aac(6’)-Ib、ant(3’)-I基因检测阳性率分别为52.78%、33.33%、20.37%、9.26%、12.04%、4.63%、59.26%、34.26%、14.81%,2013年的126株分离菌阳性率分别为53.17%、34.13%、31.75%、12.04%、12.04%、5.56%、36.51%、46.83%、15.87%,2014年的134株分离菌阳性率分别为54.48%、36.51%、33.58%、21.64%、16.42%、8.73%、55.97%、48.51%、10.45%。结论肿瘤科患者感染的鲍曼不动杆菌耐药严重,耐药程度逐年增强,其耐药机制与耐药基因高携带率有关。
Objective To study the drug resistance changes and drug resistance mechanism of Acinetobacter baumannii infection in oncology patients and provide guidance for clinical treatment and drug resistance control. Methods The clinical specimens from patients with oncology in our hospital from January 2012 to December 2014 were collected and single colonies were picked for strain identification. KB method was used for drug susceptibility testing. Bacterial DNA was extracted for PCR amplification to detect drug resistance gene distribution . Results A total of 368 Acinetobacter baumannii isolates were isolated, including 108 in 2012, 126 in 2013 and 134 in 2014. Drug resistance analysis showed that Acinetobacter baumannii isolates were resistant to amikacin, ceftriaxone, ceftazidime, cefotaxime, cefepime, ciprofloxacin, imipenem and levofloxacin The degree of medicine increased year by year. The Acinetobacter baumannii OXA-58, ant (3 ’) - I, OXA-23, IMP, PER, OXA-24, TEM, aac (3) -Ia and aac (6’) - Ib gene sizes were 507, 284, 291, 587, 961, 496, 535, 337 and 597 bp, respectively. In 108 isolates from 2012, TEM, PER, OXA-23, OXA-24, OXA-58, IMP, aac (3) -Ia, aac (6 ’) - Ib, ant (3’) - I The positive rates of gene detection were 52.78%, 33.33%, 20.37%, 9.26%, 12.04%, 4.63%, 59.26%, 34.26%, 14.81% respectively. The positive rates of 126 isolates in 2013 were 53.17%, 34.13% The positive rates of 134 isolates in 2014 were 54.48%, 36.51%, 33.58%, 21.64%, 16.42% and 8.73%, respectively. The positive rates of 134 isolates in 2014 were 31.5%, 12.04%, 12.04%, 5.66%, 36.51%, 46.83% and 15.87% 55.97%, 48.51%, 10.45%. Conclusion The Acinetobacter baumannii infection in oncology patients is serious and their drug resistance is enhanced year by year. The mechanism of drug resistance is related to the high carrying rate of drug resistance genes.