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目的了解多药耐药鲍氏不动杆菌耐药谱,研究鲍氏不动杆菌对亚胺培南的耐药性及耐药机制。方法用VITEK60型全自动药敏分析系统鉴定药敏系统及纸片扩散法进行药敏试验;酶三维试验检测ESBLs和AmpC酶;PCR扩增和测序分析检测碳青酶烯酶VIMI、MP、OXA-23和OXA-24;SDS-PAGE方法研究外膜蛋白表达情况;利血平协同抑制试验检测膜外排机制。结果156株多药耐药菌中有120株来自痰液(76.9%),其次是各种创面分泌物16株;病区分布则以ICU为主51株;头孢哌酮/舒巴坦耐药率最低,其次是亚胺培南,20株亚胺培南耐药菌中,ESBLs和AmpC酶阳性株分别为10株(50.0%)和20株(100.0%),PCR扩增VIM、IMP和OXA-24均阴性;OXA-23基因扩增显示19株(95%)阳性,PCR产物并经序列分析证实为OXA-23;与敏感株相比,部分菌株存在22×103、29×103、33×103的外膜蛋白缺失;利血平不能降低亚胺培南对鲍氏不动杆菌的MIC值。结论ICU是多药耐药鲍氏不动杆菌最主要的感染科室,碳青酶烯类抗菌药物的长期广泛应用使鲍氏不动杆菌的耐药率不断升高;产OXA-23型β-内酰胺酶是鲍氏不动杆菌对亚胺培南耐药的重要原因,产AmpC酶合并外膜蛋白缺失与鲍氏不动杆菌对亚胺培南耐药有密切关系。
Objective To understand the drug resistance spectrum of multidrug-resistant Acinetobacter baumannii and investigate the drug resistance and drug resistance of Acinetobacter baumannii to imipenem. Methods Antibiotic susceptibility test was carried out by using VITEK60 automatic drug sensitivity analysis system and disk diffusion method. ESBLs and AmpC enzyme were detected by enzyme three-dimensional test. The activities of VIMI, MP, OXA -23 and OXA-24; SDS-PAGE method to study the expression of outer membrane protein; reserpine synergistic inhibition assay to detect membrane efflux mechanism. Results Among the 156 multidrugresistant bacteria, 120 were from sputum (76.9%), followed by 16 wounds of various wounds. The prevalence of ICU was 51 in the ward, and cefoperazone / sulbactam Among the 20 imipenem-resistant strains, 10 (50.0%) and 20 (100.0%) ESBLs-positive and AmpC-positive were PCR-amplified VIM, IMP and OXA-23 was negative. OXA-23 gene amplification showed that 19 (95%) were positive. PCR products were confirmed by sequence analysis as OXA-23. Compared with the susceptible strains, some strains were 22 × 103,29 × 103, 33 × 103 of the outer membrane protein is missing; reserpine does not reduce the imipenem against Acinetobacter baumanii MIC value. Conclusion ICU is the most important infection department of multidrug-resistant Acinetobacter baumannii. The long-term application of carbapenem-based antimicrobial agents has led to an increasing rate of drug resistance of Acinetobacter baumannii. The production of OXA-23 β- Lactamase is an important cause of imipenem-resistant Acinetobacter baumannii, the production of AmpC enzyme with outer membrane protein loss and Acinetobacter baumannii resistance to imipenem are closely related.