多重耐药鲍曼不动杆菌临床株分布及耐药性

Clinical distribution and drug resistance of multidrug-resistant Acinetobacter baumannii

    摘要
  • 摘要:
    目的 了解厦门某医院临床检出的多重耐药鲍曼不动杆菌(MDRAB)分布特点和耐药性, 并研究MDRAB分离菌株抗药基因相关插入序列元件(IS)和转座子(Tn)的携带情况。
    方法 收集陆军第七十三集团军医院2016年1月-2024年2月住院患者检出的鲍曼不动杆菌300株, 采用全自动细菌鉴定仪与药敏试验进行细菌鉴定和耐药性分析。通过聚合酶链式反应(PCR)对MDRAB菌株进行6种Tn遗传标记(merA、TnpU、TnpM、TnpR、TnpA21、TnpA7)和3种IS基因(ISEcp1、ISCR1、IS26)检测；并对检测的IS和Tn阳性的基因进行测序比对验证。
    结果 300株鲍曼不动杆菌菌株中多重耐药株49株, MDRAB菌株大多见于75岁以上的患者(44.90%), 主要分离自神经医学中心ICU(34.69%)、重症医学科ICU(20.41%)和呼吸内科(16.33%)；其中以痰液标本为主(77.55%)。MDRAB对头孢泊肟、呋喃妥因及氨曲南耐药率均较高(≥97%), MDRAB菌株对绝大部分抗菌药物的耐药率>80%, 而对多黏菌素(12.24%)和替加环素(28.57%)较敏感；与非MDRAB菌株相比, 对常见抗菌药物耐药差异具有统计学意义(P＜0.05)。MDRAB菌株中, IS和Tn检出ISCR1、IS26、TnpU和TnpM基因, 检出率分别为51.02%、48.98%、51.02%和22.45%, merA、TnpR、TnpA21、TnpA7、ISEcp1均未检出。
    结论 鲍曼不动杆菌的耐药情况较严重, 尤其对于高龄重症患者, MDRAB菌株的传播可能与ISCR1、IS26、TnpM和TnpU基因相关。

     

    Abstract:
    OBJECTIVE To investigate the distribution characteristics and drug resistance of multidrug-resistant Acinetobacter baumannii (MDRAB) detected clinically in the Army 73rd Group Military Hospital in Xiamen, and to study the carrying conditions of drug-resistant gene-related insertion sequence elements (IS) and transposons (Tn) in the isolated strains of MDRAB.
    METHODS A total of 300 strains of Acinetobacter baumannii detected from inpatients admitted to the Army 73rd Group Military Hospital from Jan. 2016 to Feb. 2024 were collected. Automatic bacterial identification instruments and drug susceptibility tests were used for bacterial identification and drug resistance analysis. Polymerase chain reaction (PCR) was employed to detect 6 Tn genetic markers (merA, TnpU, TnpM, TnpR, TnpA21, TnpA7) and 3 IS genes (ISEcp1, ISCR1, IS26) in MDRAB strains. The detected IS and Tn-positive genes were subjected to sequencing and alignment verification.
    RESULTS Among 300 Acinetobacter baumannii strains, 49 (16.33%) were MDRAB. Most MDRAB strains were found in patients aged 75 and above (44.90%), mainly isolated from the brain center ICU (34.69%), critical care medicine ICU (20.41%), and respiratory medicine department (16.33%), sputum specimens accounted for the majority (77.55%). MDRAB strains exhibited high drug resistance rates (≥97%) to cefpodoxime, nitrofurantoin, and aztreonam. MDRAB strains showed drug resistance rates >80% to most antimicrobial agents, but were sensitive to polymyxin (12.24%) and tigecycline (28.57%). Compared with non-MDRAB strains, there were statistically significant differences in drug resistance to common antimicrobial agents (P < 0.05). Among MDRAB strains, ISCR1, IS26, TnpU and TnpM genes were detected in IS and Tn, with detection rates of 51.02%, 48.98%, 51.02% and 22.45%, respectively. merA, TnpR, TnpA21, TnpA7 and ISEcp1 were not detected.
    CONCLUSIONS The drug resistance of Acinetobacter baumannii is severe, especially in elderly and critically ill patients. The transmission of MDRAB strains may be associated with the genes ISCR1, IS26, TnpM and TnpU.

     

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