上海地区四家医院鲍曼不动杆菌产β-内酰胺酶研究

检验医学 ›› 2012, Vol. 27 ›› Issue (2): 103-109.

上海地区四家医院鲍曼不动杆菌产β-内酰胺酶研究

1.上海交通大学医学院附属仁济医院检验科，上海 200127；2.上海交通大学医学院附属瑞金医院微生物科，上海 200025；3.同济大学附属东方医院检验科，上海 200120；4.上海浦东新区公利医院检验科，上海 200135；5.上海迪安临床检验中心，上海 200433

出版日期:2012-02-28 发布日期:2012-02-19
通讯作者: 应春妹，联系电话：021-58752345-3299。
作者简介:杜　坤，男，1985年生，学士，主要从事细菌耐药机制研究。
基金资助:
上海市浦东新区卫生局卫生科技项目（PW2010D-3）

The study on Acinetobacter baumannii beta-lactamases in four hospitals of Shanghai

1. Department of Clinical Laboratory， Renji Hospital， Shanghai Jiaotong University School of Medicine， Shanghai 200127， China; 2. Department of Microbiology， Ruijin Hospital， Shanghai Jiaotong University School of Medicine， Shanghai 200025， China；3. Department of Clinical Laboratory， East Hospital, Tongji University， Shanghai 200120， China；4. Department of Clinical Laboratory， Shanghai Pudong New Area Gongli Hospital，Shanghai 200135，China；5.Shanghai D.A Medical Laboratory Co.，LTD.,Shanghai 200433, China

Online:2012-02-28 Published:2012-02-19

摘要/Abstract

摘要： 目的　了解上海地区4家医院2010年鲍曼不动杆菌对13种抗菌药物耐药性及β-内酰胺酶基因携带情况，研究该菌的流行型别，为临床合理用药及控制医院感染提供依据。方法　收集上海4家医院临床分离的鲍曼不动杆菌共204株。采用琼脂稀释法检测上述细菌对13种抗菌药物的最低抑菌浓度（MIC），三维试验检测AmpC酶，乙二胺四乙酸(EDTA)纸片协同试验检测金属酶表型。聚合酶链反应（PCR）检测OXA-23、OXA-24、OXA-51、OXA-58、ampC、IMP-1、IMP-4、VIM-2编码基因。结果　4家医院鲍曼不动杆菌对环丙沙星、哌拉西林-他唑巴坦、头孢西丁、复方磺胺甲口恶唑、头孢哌酮耐药率均较高，达到90%以上；对左氧氟沙星、多黏菌素B耐药率均相对较低。研究发现浦东地区医院对美罗培南、左氧氟沙星、多黏菌素B的耐药率均高于浦西地区医院。AmpC酶表型检测以公利医院表型阳性率最高（84.6%），瑞金医院表型阳性率最低（42.3%）；金属酶表型检测，公利医院和仁济医院西院未检测到金属酶表型阳性菌株，另外3家医院中以东方医院检出率最高（27.3%），瑞金医院检出率最低（7.7%）。基因检测，浦东地区医院的OXA-23和ampC阳性率要比浦西地区医院的阳性率高。204株菌株OXA-51均为阳性，均未检测到OXA-24、OXA-58、IMP-1基因。在仁济医院东院和东方医院标本中检测到IMP-4和VIM-2基因，其他医院标本未检测到IMP-4和VIM-2基因。结论　本地区分离到的鲍曼不动杆菌均检测出OXA-51，上海地区不同医院之间鲍曼不动杆菌产β-内酰胺酶情况略有不同。

关键词: 鲍曼不动杆菌, 细菌耐药性, β-内酰胺酶

Abstract: Objective　To understand the resistance to 13 antibiotics and beta-lactamase genes in Acinetobacter baumannii in Shanghai 4 hospitals in 2010, and investigate the epidemic types, so as to provide the reference for rational use of antibiotics and control of nosocomial infections. Methods　The 204 isolates of Acinetobacter baumannii were collected from clinical specimens of 4 hospitals. Agar dilution was performed to determine the minimum inhibitory concentrations (MIC) to 13 antibiotics. Three dimensional extract test and ethylene diamine tetraacetic acid (EDTA) disc were carried out to screen AmpC enzyme and metal enzyme， respectively. OXA-23，OXA-24，OXA-51，OXA-58，ampC，IMP-1，IMP-4 and VIM-2 coding genes were amplified by polymerase chain reaction (PCR). Results　The resistance rates of these strains to ciprofloxacin，piperacillintazobactam，cefoxitin，sulfamethoxazole and cefoperazone were higher than 90%. The resistance rates of strains to levofloxacin and polymyxin B were relatively low. The resistance rates of the hospitals in Pudong to meropenem， levofloxacin and polymyxin B were higher than those of the hospitals in Puxi. The results of the three dimensional extract test showed that the positive rate of Gongli Hospital was the highest (84.6%)， and the positive rate of Ruijin Hospital was the lowest (42.3%). The results of metal enzyme phenotype testing showed that Gongli Hospital and Renji Hospital(West) did not detect the positive strains of metal enzyme phenotype， in the other 3 hospitals, the highest positive rate (27.3%) was detected in East Hospital，and the positive rate of Ruijin Hospital was the lowest (7.7%). The results of PCR amplification showed that the positive rate of Pudong hospitals was higher than that of Puxi hospitals for OXA-23 and ampC. OXA-51 were all positive in all strains，and OXA-24，OXA-58 and IMP-1 were all negative. IMP-4 and VIM-2 were detected at Renji Hospital(East) and East Hospital，while they were not detected in Gongli Hospital， Ruijin Hospital and Renji Hospital(West). Conclusions　OXA-51 is detected in the isolates of Acinetobacter baumannii， and there is slight difference between different hospitals in the mechanism of Acinetobacter baumannii beta-lactamases.

Key words: Acinetobacter baumannii, Bacterial resistance, Beta-lactamase

杜坤;应春妹;汪雅萍;杨海慧;孙景勇;张雯雁;华玲;于嘉屏. 上海地区四家医院鲍曼不动杆菌产β-内酰胺酶研究[J]. 检验医学, 2012, 27(2): 103-109.

DU Kun;YING Chunmei;WANG Yaping;YANG Haihui;SUN Jingyong;ZHANG Wenyan;HUA Ling;YU Jiaping. The study on Acinetobacter baumannii beta-lactamases in four hospitals of Shanghai[J]. , 2012, 27(2): 103-109.

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