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目的了解杭州市第一人民医院临床分离的鲍曼不动杆菌菌株分布及其对常用抗菌药物的耐药性和耐药基因分布。方法分析2015年1月至12月杭州市第一人民医院常规细菌分离培养的鲍曼不动杆菌的分布情况以及耐药性,从中筛选出40株多重耐药菌株(MDR-AB),并采用聚合酶链式反应(PCR)检测相关耐药基因。结果共检出1 112株鲍曼不动杆菌,其中以痰液标本的分离率最高82.37%(916/1 112),其次为洁尿8.99%(100/1 112)。临床分布以ICU为主61.60%(685/1 112),其次为老年干部病房11.60%(129/1 112)以及呼吸内科9.98%(111/1 112)。鲍曼不动杆菌对21种常用抗菌药物的耐药率中以替加环素耐药率最低9.8%(109/1 112),其次为阿米卡星25.2%(280/1 112);对头孢西丁、头孢美唑、阿莫西林/克拉维酸耐药率最高分别为99.7%(1 109/1 112)、100.0%(1 112/1 112)、98.8%(1 099/1 112)。40株MDR-AB菌株耐药基因Tem、SHV、CTX-M-9、OXA-23、aac(3)-II、aac(6′)-Ⅰ、aac(6′)-II、ant(3″)-Ⅰ、ant(2″)-Ⅰ、ParC、GyrA、tetA、tetR检出率分别为65.0%、72.5%、70.0%、72.5%、2.5%、55.0%、87.5%、55.0%、40.0%、92.5%、87.5%、15.0%、12.5%。结论本院鲍曼不动杆菌耐药情况严重,耐药机制复杂。
Objective To investigate the clinical isolates of Acinetobacter baumannii isolated from First People’s Hospital of Hangzhou and their drug resistance and resistance gene distribution to commonly used antibiotics. Methods The distribution and drug resistance of Acinetobacter baumannii isolated from routine bacteria in Hangzhou First People’s Hospital from January to December 2015 were analyzed. Forty multi-drug resistant strains (MDR-AB) were screened out and used Polymerase chain reaction (PCR) detection of related resistance genes. Results A total of 1 112 strains of Acinetobacter baumannii were detected. Among them, the highest separation rate was sputum smear 82.37% (916/1 112), followed by clean urine 8.99% (100/1 112). The clinical distribution was mainly ICU 61.60% (685/1 112), followed by elderly elder ward 11.60% (129/1 112) and respiratory medicine 9.98% (111/1 112). Acinetobacter baumannii had the lowest rate of resistance to tigecycline among the 21 commonly used antibiotics, 9.8% (109/1 112), followed by 25.2% (280/1 112) for amikacin; The highest rates of resistance to cefoxitin, cefmetazole and amoxicillin / clavulanic acid were 99.7% (1 109/1 112), 100.0% (1 112/1 112) and 98.8% (1 099/1 112) . The resistance genes of 40 MDR-AB strains were identified as Tem, SHV, CTX-M-9, OXA-23, aac (3) -II, aac (6 ’ The detection rates of antisense oligonucleotide, antisense oligonucleotide and antisense antisense oligonucleotide were 65.0%, 72.5%, 70.0%, 72.5%, 2.5%, 55.0%, 87.5%, 55.0% and 40.0% , 92.5%, 87.5%, 15.0%, 12.5%. Conclusion Acinetobacter baumannii in our hospital has serious drug resistance and complicated drug resistance mechanism.