本文關(guān)鍵詞：臨床分離的鮑曼不動(dòng)桿菌耐消毒劑基因研究及同源性分析　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 鮑曼不動(dòng)桿菌 碳青霉烯酶 多重耐藥 消毒劑抗性 基因分型 rep-PCR

【摘要】：目的:分析2013年10月至2014年8月四川醫(yī)科大學(xué)第一院附屬醫(yī)院和四川省自貢市第一人民醫(yī)院臨床分離的133株鮑曼不動(dòng)桿菌臨床分布情況、碳青霉烯酶產(chǎn)生情況以及對(duì)18種抗菌藥物的耐藥譜特征,為臨床合理使用抗生素提供科學(xué)依據(jù);檢測(cè)鮑曼不動(dòng)桿菌的耐消毒劑基因qacE?1的攜帶情況,為醫(yī)院感染防控提供實(shí)驗(yàn)依據(jù);同時(shí),分析碳青霉烯酶陽(yáng)性組鮑曼不動(dòng)桿菌的分子流行病學(xué)特點(diǎn)。方法:收集2013年10月至2014年8月臨床標(biāo)本中分離的鮑曼不動(dòng)桿菌共133株,統(tǒng)計(jì)分析菌株臨床分布情況;采用MicroScan WalkAway 96 Plus全自動(dòng)微生物鑒定/藥敏測(cè)試系統(tǒng)檢測(cè)18種臨床常用抗菌藥物的藥物敏感性試驗(yàn),同時(shí)采用改良Hodge試驗(yàn)檢測(cè)碳青霉烯酶表型,將133株鮑曼不動(dòng)桿菌分為碳青霉烯酶陽(yáng)性組和碳青霉烯酶陰性組;運(yùn)用聚合酶鏈反應(yīng)(Polymerase Chain Reaction,PCR)檢測(cè)耐消毒劑基因qacE?1的總體攜帶情況,χ2檢驗(yàn)比較分析碳青霉烯酶陽(yáng)性組與碳青霉烯酶陰性組之間耐消毒劑基因qacE?1的攜帶率是否存在差異性;隨機(jī)抽取qacE?1基因陽(yáng)性菌株進(jìn)行測(cè)序;運(yùn)用重復(fù)序列PCR技術(shù)(repetitive element PCR,rep-PCR)分析碳青霉烯酶陽(yáng)性組鮑曼不動(dòng)桿菌的同源性。結(jié)果:133株臨床分離鮑曼不動(dòng)桿菌主要分離于痰標(biāo)本,占73.7%,其次為分泌物標(biāo)本,占13.5%;科室分布主要在重癥監(jiān)護(hù)病房(ICU)56株,占42.1%,其次是呼吸內(nèi)科27株,占20.3%。藥敏試驗(yàn)結(jié)果顯示除對(duì)頭孢哌酮/舒巴坦(29.3%)和復(fù)方新諾明(35.3%)的耐藥率較低外,對(duì)其余16種臨床常用的抗菌藥物普遍耐藥。改良Hodge試驗(yàn)將133株鮑曼不動(dòng)桿菌分為兩組,其中碳青霉烯酶陽(yáng)性組97株,碳青霉烯酶陰性組36株。133株鮑曼不動(dòng)桿菌中共檢出112株qacE?1基因陽(yáng)性菌株,總陽(yáng)性攜帶率為84.2%,其中碳青霉烯酶陽(yáng)性組中檢出84株攜帶qacE?1基因,陽(yáng)性攜帶率為86.6%,碳青霉烯酶陰性組中檢出28株攜帶qacE?1基因,陽(yáng)性攜帶率為77.8%。兩組相比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。隨機(jī)抽取的qacE?1基因陽(yáng)性標(biāo)本的基因測(cè)序結(jié)果與GeneBank中相應(yīng)基因序列相比較,同源性為98%。運(yùn)用rep-PCR將碳青霉烯酶陽(yáng)性組的鮑曼不動(dòng)桿菌分為4個(gè)基因型,其中A型66株,為主要流行克隆株。結(jié)論:1、呼吸道是臨床鮑曼不動(dòng)桿菌感染的主要途徑,且有較為明顯的病區(qū)集中趨勢(shì)。2、臨床分離的鮑曼不動(dòng)桿菌除對(duì)頭孢哌酮/舒巴坦較為敏感外,對(duì)多種抗菌藥物普遍耐藥,耐藥情況嚴(yán)峻。3、四川醫(yī)科大學(xué)第一附屬醫(yī)院和四川省自貢市第一人民醫(yī)院臨床分離的133株鮑曼不動(dòng)桿菌的耐消毒劑qacE?1基因攜帶率高,且與碳青霉烯酶表型無(wú)關(guān)。4、碳青霉烯酶陽(yáng)性鮑曼不動(dòng)桿菌以A型為主要感染流行。
[Abstract]:Objective: to analyze the clinical distribution of Acinetobacter baumannii isolated from the affiliated Hospital of the first Hospital of Sichuan Medical University and the first people's Hospital of Zigong City from October 2013 to August 2014. The production of carbapenem and the characteristics of resistance to 18 antimicrobial agents provide scientific basis for the rational use of antibiotics in clinic. The disinfectant resistant gene qacE of Acinetobacter baumannii was detected. 1) to provide experimental basis for the prevention and control of nosocomial infection; Meanwhile, the molecular epidemiological characteristics of Acinetobacter baumannii in carbapenem positive group were analyzed. Methods: 133 strains of Acinetobacter baumannii isolated from clinical specimens from October 2013 to August 2014 were collected. Statistical analysis of the clinical distribution of strains; MicroScan WalkAway 96 Plus automatic microbiological identification / drug sensitivity test system was used to detect the drug sensitivity of 18 kinds of commonly used antimicrobial agents in clinic. At the same time, 133 strains of Acinetobacter baumannii were divided into carbapenase positive group and carbapenem negative group by modified Hodge test. Polymerase chain reaction (PCR) was used to detect the disinfectant resistant gene qacE? (1) the total carrying status, 蠂 2 test, were compared to analyze the disinfectant resistance gene qacE between carbapenase positive group and carbapenem negative group. Is there any difference in carrying rate of Q1; random sampling of qacE? 1Gene positive strains were sequenced; Repetitive element PCR was used by repeated sequence PCR technique. Rep-PCR was used to analyze the homology of Acinetobacter baumannii in carbapenem positive group. Results 73.7% strains of Acinetobacter baumannii were isolated from sputum samples. The second was secretion specimen, accounting for 13.5; There were 56 ICUU strains in intensive care unit, accounting for 42.1%, followed by 27 strains in respiratory medicine department. The results of drug sensitivity test showed that the drug resistance rate was lower except for cefoperazone / sulbactam 29.3) and compound sulbactam 35.3B). The modified Hodge test divided 133 strains of Acinetobacter baumannii into two groups, 97 of which were carbapenase positive. A total of 112 strains of Acinetobacter baumannii were detected in the carbapenem negative group of 36 strains. 133 strains of Acinetobacter baumannii. The total positive rate was 84.2%, and 84 strains were found to carry qacE in the carbapenase positive group. 1 gene, the positive rate was 86. 6%, 28 strains were found to carry qacE in carbapenem negative group. 1 the positive rate of the gene was 77.8%. There was no significant difference between the two groups (P 0.05). 1 the results of gene sequencing in the positive samples were compared with the corresponding gene sequences in GeneBank. The homology was 98. Acinetobacter baumannii in carbapenem positive group was divided into 4 genotypes by rep-PCR. Respiratory tract is the main way of clinical Acinetobacter baumannii infection, and there is a more obvious trend of concentration. 2. Acinetobacter baumannii isolated clinically is sensitive to cefoperazone / sulbactam. Generally resistant to many kinds of antimicrobial agents, the situation of drug resistance is severe. 3. 133 strains of Acinetobacter baumannii were isolated from the first affiliated Hospital of Sichuan Medical University and the first people's Hospital of Zigong City Sichuan Province. 1 the gene carrying rate was high and had no correlation with carbapenem phenotype. Acinetobacter baumannii positive with carbapenem enzyme was the main type of infection in Acinetobacter baumannii.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R446.5

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本文編號(hào)：1373853