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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

26卷

期数:

2020年05期

页码:

471-475

栏目:

临床医学

出版日期:

2020-09-20

文章信息/Info

Title:

Clinical characteristics and clonal dynamics of carbapenem-resistant Acinetobacter baumannii infections

文章编号:

1006-8147(2020)05-0471-05

作者:

孔海芳; 胡志东

（天津医科大学总医院医学检验科，天津 300052）

Author(s):

KONG Hai-fang;  HU Zhi-dong

（Clinical Laboratory，General Hospital，Tianjin Medical University, Tianjin 300052，China)

关键词:

鲍曼不动杆菌; 碳青霉烯酶; 脉冲场凝胶电泳; 耐药

Keywords:

Acinetobacter baumannii; Carbapenemases; pulsed field gel electrophoresis; resistance

分类号:

R446.5

DOI:

-

文献标志码:

A

摘要:

目的：研究天津医科大学总医院碳青霉烯耐药鲍曼不动杆菌（CRAB）的临床特征、耐药机制以及克隆变迁情况。方法：回顾性分析天津医科大学总医院2011年1月—2018年12月感染CRAB患者的临 床资料；采用聚合酶链反应（PCR）检测CRAB的碳青霉烯酶基因；应用脉冲场凝胶电泳（PFGE）对CRAB进行分子流行病学分型。结果：该院CRAB对庆大霉素、环丙沙星、左氧氟沙星的耐药性较高，且 97.5%的菌株blaOXA-23基因阳性，未检测出blaOXA-24-like 、blaOXA-58-like、blaIMP、blaVIM、blaSIM、 blaNDM基因。PFGE将2011-2015年79株CRAB分成15个克隆型，以A克隆型和C克隆型为主，2011 年CRAB呈散在流行，2012年以C克隆型为主，2013年A克隆型出现，并取代C克隆型成为2013—2015年主要的流行菌株。A克隆型对亚胺培南高度耐药（MIC50 =64 μg/mL），对美罗培南中度耐药（MIC50 =16 μg/mL），且与中央静脉插管相关（χ2 =5.80，P=0.016）；C克隆型对亚胺培南中度耐药（MIC50 =16 μg/mL），对美罗培南低度耐药（MIC50 =8 μg/mL），且与三代头孢菌素的使用相关（χ2 =4.65，P=0.031）。结论：blaOXA-23基因是该院CRAB最主要的碳青霉烯酶基因，对亚胺培南和美罗培南高中度耐药的A克隆型是该院流行传播的主要克隆型。

Abstract:

Objective: To determine the clinical characteristics, carbapenem-resistance genes, clonal dynamics of carbapenem-resistant Acinitobacter baumannii(CRAB) in General Hospital of Tianjin Medical University. Methods: A total of 242 isolates of CRAB were identified during a period ranging from January 2011 to December 2018 in the General Hospital of Tianjin Medical University, and the clinical characteristics of infected patients were retrospectively analyzed. Polymerase chain reaction(PCR) was performed for detection of blaOXA-51-like , blaOXA-23-like , blaOXA-24-like , blaOXA-58-like , blaIMP , blaVIM , blaNDM , blaSIM genes in isolates; clonal dynamics of those isolates was determined using pulsed-field gel electrophoresis (PFGE). Results: A total of CRAB were highly resistant to gentamincin, ciprofloxacin and levofloxacin. Molecular analysis demonstrated that carbapenemase genes blaOXA-51 were presented in all 242 isolates, and 97.5% of isolates carried the blaOXA-23 gene, but blaOXA-24-like , blaOXA-58-like , blaIMP ,blaVIM , blaNDM , blaSIM genes were completely absent in all isolates. Clones were detected by PFGE in 79 isolates and showed 15 different restriction patterns in 2011— 2015. Of the 15 different clones obtained, 2 clones were classified as predominant clones which were named as clone A and clone C. The strains of CRAB were sporadic in 2011, clone C was detected in 2011 and remained present until the end of the study in 2015, which was the predominant clone in 2012. Clone A displaced clone C as the predominant clone from 2013 to 2015, which was first detected in 2013. Clone A was highly resistant to imipenem(MIC50=64 μg/mL) and moderately resistant to meropenem (MIC50=16 μg/mL), which was associated with CVCs( χ2 =5.80，P=0.016). Clone C was moderately resistant to imipenem(MIC50=16 μg/mL) and lowly resistant to meropenem(MIC50=8 μg/mL), which was associated with previous use of third-generation cephalosporins( χ2=4.65，P=0.031). Conclusion: OXA-23 carbapenemase production is the major contributors to the high frequency of CRAB. At present, clone A with high and moderate resistance to imipenem and meropenem is disseminated in different wards, indicating that there is a longstanding infection control problem in our hospital.

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备注/Memo

备注/Memo:

作者简介 孔海芳（1990-），女，初级检验技师，硕士，研究方向：临床检验诊断学；
通信作者：胡志东，E-mail: huzhidong27@163.com。

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更新日期/Last Update: 2020-09-18