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目的探讨泛耐药鲍氏不动杆菌获得性耐药基因与可移动遗传、耐药元件的携带及关联性,为临床治疗提供参考依据。方法收集2014年住院患者中分离的20株泛耐药鲍氏不动杆菌,用mdfA测序确认菌种,再采用聚合酶链反应(PCR)及序列分析的方法,分析32种β-内酰胺类药物获得性耐药基因,对获得性耐药基因与可移动遗传元件标记测得结果作指标聚类分析。结果 20株泛耐药鲍氏不动杆菌共检出4种β-内酰胺类获得性耐药基因、1种膜孔蛋白基因、3种氨基糖苷类获得性耐药基因、1种外排泵泵蛋白基因、5种可移动遗传元件遗传标记,且阳性率非常高;blaOXA-23群和插入序列ISaba1的连锁检测均呈阳性;指标聚类分析提示β-内酰胺类获得性耐药基因blaTEM、blaADC、blaOXA-23群、blaOXA-51群,氨基糖苷类获得性耐药基因aph3′-Ⅰ与可移动遗传元件中的ISaba1、intⅠ1均高度相关;外排泵泵蛋白基因adeB与IS26高度相关,氨基糖苷类获得性耐药基因aac3-Ⅰ与tnpU、tnp513亦高度相关。结论泛耐药鲍氏不动杆菌中携带的耐药基因和耐药表型相对应,携带blaTEM、blaADC、blaOXA-23群、blaOXA-51群、膜孔蛋白基因carO2缺失、aph3′-Ⅰ及外排泵泵蛋白基因adeB,是泛耐药鲍氏不动杆菌对β-内酰胺类、氨基糖苷类、氟喹诺酮类耐药的重要原因。
OBJECTIVE To investigate the inheritance and association of the acquired resistance genes and the mobile genetic and resistant elements of the pan-resistant Acinetobacter baumannii and to provide a reference for clinical treatment. Methods Twenty strains of Pan-drug-resistant Acinetobacter baumannii isolated from hospitalized patients in 2014 were collected. The strains were identified by mdfA sequencing. Then, by polymerase chain reaction (PCR) and sequence analysis, 32 kinds of β-lactams Drug-acquired drug resistance genes, cluster analysis of indicators of acquired resistance genes and markers of mobile genetic elements. Results Four kinds of β-lactam resistance genes, one membrane pore protein gene, three aminoglycoside-acquired resistance genes and one efflux pump were detected in 20 strains of Pan-drug-resistant Acinetobacter baumannii The results showed that the positive rate of blaOXA-23 was high, the positive rate of blaOXA-23 was high, and the positive rate of blaOXA-23 was the same as that of ISaba1. The cluster analysis indicated that the gene of β-lactam resistance was blaTEM , BlaADC, blaOXA-23 group, blaOXA-51 group, aminoglycoside-acquired resistance gene aph3’-Ⅰwas highly correlated with ISaba1 and intⅠ1 in mobile genetic elements; efflux pump protein gene adeB was highly correlated with IS26 The aminoglycoside-acquired resistance gene aac3-I was also highly correlated with tnpU and tnp513. Conclusions The resistant genes and resistant phenotypes in the pan-resistant Acinetobacter baumannii correspond to blaTEM, blaADC, blaOXA-23, blaOXA-51, membrane pore protein gene carO2, aph3’-Ⅰ and Outbrain pump protein gene adeB, Pan-resistant Acinetobacter baumannii β-lactams, aminoglycosides, fluoroquinolones resistance of the important reasons.