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目的研究高血压患者上呼吸道感染鲍曼不动杆菌耐药基因及耐药性变迁情况,为临床感染性疾病的预防和控制提供指导。方法收集本院高血压上呼吸道感染患者痰液标本,分离鲍曼不动杆菌,K-B法进行耐药性分析,PCR扩增法进行耐药基因检测。结果 2013-2015年共分离鲍曼不动杆菌377株,各菌株对氨曲南耐药率100%,对头孢吡肟、头孢噻肟、头孢他啶、左氧氟沙星和氨苄西林耐药率分别为77.98%、77.45%、77.98%、70.56%和74.27%,对阿米卡星和亚胺培南耐药率分别为35.28%和34.22%。377株鲍曼不动杆菌OXA-23、OXA-58、TEM、PER、IMP和CTX-M-9等耐药基因阳性菌株分别为141、44、133、68、61和22株,阳性率分别为37.40%、11.67%、35.28%、18.04%、16.18%和5.84%。2013-2015年各年度鲍曼不动杆菌OXA-23、OXA-58、TEM、PER、IMP、CTX-M-9基因阳性率分别为27.36%、4.72%、32.08%、16.04%、9.43%、3.77%,32.28%、11.81%、34.65%、18.90%、11.02%、4.72%和49.31%、16.67%、38.19%、18.75%、25.69%、8.33%。各耐药基因检测阳性率呈逐年升高趋势。结论 2013-2015年高血压上呼吸道感染者鲍曼不动杆菌对头孢类抗生素的耐药明显,耐药基因阳性率逐年升高,耐药基因检测对防控病原菌耐药性发展具有重要意义。
Objective To study the changes of resistance gene and drug resistance of Acinetobacter baumannii in upper respiratory tract infection in hypertensive patients and provide guidance for the prevention and control of clinical infectious diseases. Methods Sputum specimens of patients with hypertension in upper respiratory tract infection were collected, Acinetobacter baumannii was isolated, and drug resistance analysis was performed by K-B method. The drug resistance gene was detected by PCR amplification. Results A total of 377 Acinetobacter baumannii isolates were isolated from 2013 to 2015. The resistance rate of aztreonam to each strain was 100%. The rates of resistance to cefepime, cefotaxime, ceftazidime, levofloxacin and ampicillin were 77.98% 77.45%, 77.98%, 70.56% and 74.27%, respectively. The rates of resistance to amikacin and imipenem were 35.28% and 34.22%, respectively. 377 Acinetobacter baumannii strains OXA-23, OXA-58, TEM, PER, IMP and CTX-M-9 were 141,44,133,68,61 and 22 strains respectively. The positive rates were 37.40%, 11.67%, 35.28%, 18.04%, 16.18% and 5.84% respectively. The positive rates of OXA-23, OXA-58, TEM, PER, IMP and CTX-M-9 genes in Acinetobacter baumannii from 2013 to 2015 were 27.36%, 4.72%, 32.08%, 16.04% and 9.43% 3.77%, 32.28%, 11.81%, 34.65%, 18.90%, 11.02%, 4.72% and 49.31%, 16.67%, 38.19%, 18.75%, 25.69%, 8.33% respectively. The positive rate of each drug resistance test showed a rising trend year by year. Conclusion Acinetobacter baumannii was significantly resistant to cephalosporins in patients with upper respiratory tract infection of hypertension during 2013-2015, and the positive rate of drug resistance genes was increased year by year. The detection of drug resistance genes is of great significance in preventing and controlling the development of drug resistance of pathogens.