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目的调查医院重症监护病房(ICU)分离鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制,为ICU鲍氏不动杆菌感染治疗的抗菌药物选择提供理论依据。方法收集2010年1月-2014年1月ICU住院患者分离到的135株非重复鲍氏不动杆菌,采用VITEK-2Compact全自动微生物分析系统进行鉴定及药敏分析,采用PCR法检测blaVIM、blaNDM、blaOXA-23/24、blaIMP、blaKPC及blaOXA-51/58等碳青霉烯酶耐药基因,采用PCR检测ISAba1基因并与碳青霉烯酶基因连锁检测。结果 4年ICU分离出鲍氏不动杆菌135株,年龄>60岁患者分离的鲍氏不动杆菌最多52株,占38.52%;ICU患者痰液标本中检出鲍氏不动杆菌最多79株占58.52%,其次为分泌物及尿液,分别占20.00%及11.11%;鲍氏不动杆菌对氨苄西林耐药率最高为94.81%,对美罗培南和亚胺培南的耐药率分别为32.95%和34.07%;对选取的46株碳青霉烯类耐药菌进行基因检测显示,46株均携带有blaOXA-51-like基因,46株菌携带ISAba1基因;40株携带blaOXA-23-like基因,对blaOXA-23-like基因测序,进行比对后确定为blaOXA-23基因,并同时检出ISAba1-blaOXA-23连锁基因;未检出blaKPC、blaIMP、blaVIM、blaOXA-58-like、blaOXA-24-like及blaNDM基因。结论 ICU患者分离的鲍氏不动杆菌耐药性严重,以老年患者居多,主要分离自痰液标本,其中碳青霉烯耐药株常携带有OXA-23型碳青霉烯酶基因,并与ISAba1连锁携带。
Objective To investigate the mechanism of resistance to carbapenem antibiotics isolated from intensive care unit (ICU) in hospital intensive care unit (ICU) and to provide a theoretical basis for the selection of antibacterials for the treatment of Acinetobacter baumannii infection in ICU. Methods A total of 135 non-repetitive Acinetobacter baumannii isolates from hospitalized patients in ICU from January 2010 to January 2014 were collected and identified by VITEK-2 Compact automated microbiological analysis system. Drug susceptibility analysis was performed using blaVIM, blaNDM , BlaOXA-23/24, blaIMP, blaKPC and blaOXA-51/58 carbapenem resistance genes were detected by PCR detection of ISAba1 gene and carbapenemase gene chain test. Results A total of 135 strains of Acinetobacter baumannii isolated from the ICU in 4 years were collected. Acinetobacter baumannii isolated from patients aged> 60 years showed a maximum of 52 strains (38.52%). Acinetobacter baumannii Accounting for 58.52%, followed by secretions and urine, accounting for 20.00% and 11.11% respectively. The highest rate of resistance to ampicillin in Acinetobacter baumannii was 94.81%, and the rates of resistance to meropenem and imipenem were 32.95% and 34.07% respectively. 46 of the 46 strains of carbapenem-resistant isolates carried blaOXA-51-like gene and 46 strains of bacteria carried ISAba1 gene. Forty-eight strains harboring blaOXA-23- like gene. After blaOXA-23-like gene was sequenced, the blaOXA-23 gene was identified and the ISAba1-blaOXA-23 gene was detected simultaneously. No blaKPC, blaIMP, blaVIM, blaOXA-58- blaOXA-24-like and blaNDM genes. Conclusion Acinetobacter baumannii isolated from ICU patients is seriously drug-resistant, mostly elderly patients and mainly isolated from sputum samples. Among them, carbapenem-resistant strains often carry OXA-23 carbapenemase gene Carry with ISAba1 chain.