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目的回顾分析东莞东华医院2011~2013年临床分离的鲍曼不动杆菌的临床分布及耐药特点,为临床合理用药和防止医源性感染提供依据。方法选取2011~2013年东华医院临床分离的非重复鲍曼不动杆菌菌株30株,采用琼脂稀释法检测该菌对11种抗菌药物的最低抑菌浓度(MIC),采用乙二胺四乙酸纸片协同实验检测待检菌株的金属酶表型,采用三维实验检测待检菌株的Amp C酶表型和改良Hodge实验筛查碳青霉烯酶,聚合酶链反应进行OXA-23、OXA-24编码基因的检测,应用脉冲场凝胶电泳进行同源性分析。结果在监测的14种抗菌药物MIC中,耐药率>60%的达13种,其中只有头孢哌酮舒巴坦耐药率<50%,共筛选出耐碳青霉烯酶的鲍曼不动杆菌30株,其中金属酶表型和基因检测均为阴性,Amp C酶阳性者21株,改良Hodge实验阳性24株,其中26株OXA-23基因扩增阳性,未检出OXA-24基因,可见OXA-23基因为主要的流行克隆株。结论东莞地区临床分离的鲍曼不动杆菌多重耐药十分严重,产OXA-23碳青霉烯酶是鲍曼不动杆菌对碳青霉烯酶类药物耐药的重要机制,且碳青霉烯酶耐药菌株存在克隆流行。
Objective To retrospectively analyze the clinical distribution and drug resistance characteristics of clinically isolated Acinetobacter baumannii from Donghua Hospital of Dongguan from 2011 to 2013 and provide the basis for clinical rational drug use and prevention of iatrogenic infection. Methods A total of 30 non-repetitive Acinetobacter baumannii strains isolated from Tung Wah Hospital from 2011 to 2013 were selected. The minimum inhibitory concentrations (MICs) of 11 antibacterials were detected by agar dilution method. In the synergistic experiment of paper, the phenotype of metalloenzyme of the tested strains was tested. AmpC enzyme phenotype of tested strains was tested by three-dimensional experiment and modified Hodge test was used to screen carbapenemases. The expression of OXA-23 and OXA- 24 encoding gene detection, the application of pulsed-field gel electrophoresis homology analysis. Results Among the 14 antibacterial MICs tested, 13 were resistant to> 60%, of which only cefoperazone sulbactam was less than 50%. A total of 120 strains resistant to carbapenemase were not screened out 30 strains of ACB were detected, of which 21 were positive for AmpC enzyme and 24 were for modified Hodge test, of which 26 were positive for OXA-23 gene and no OXA-24 gene was detected , Visible OXA-23 gene as the main epidemic clonal strains. Conclusion The clinical isolates of Acinetobacter baumannii in Dongguan are highly resistant to multiple antibiotics. OXA-23 carbapenemase is an important mechanism of resistance to carbapenem-resistant drugs in Acinetobacter baumannii, Enzyme-resistant strains exist clonal prevalence.