本文選題：鮑曼不動桿菌 + 血流感染��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的收集全國17家教學(xué)醫(yī)院臨床感染患者血液中分離的鮑曼不動桿菌,測定其對各類常見抗生素的敏感性,為醫(yī)院進(jìn)行感染控制和臨床合理使用抗菌藥物提供依據(jù);分析全國臨床流行株多重耐藥鮑曼不動桿菌(Multidrug-resistant Acinetobacter baumannii,MDRAB)的同源性特點(diǎn),為控制多重耐藥鮑曼不動桿菌的暴發(fā)流行提供依據(jù);對臨床90株鮑曼不動桿菌進(jìn)行毒力表型試驗(yàn),同時檢測所有菌株毒力基因的分布狀況,探究毒力因子與耐藥性、毒力因子與同源性的相關(guān)性;對臨床分離的7株粘液表型的菌株的耐藥、毒力以及同源性特點(diǎn)進(jìn)行分析。方法收集全國17家教學(xué)醫(yī)院2013年7月-2014年7月感染患者血標(biāo)本中分離鮑曼不動桿菌共90株,其中包含75株多重耐藥菌株和15株非多重耐藥菌株。采用法國生物梅里埃公司的全自動細(xì)菌鑒定儀Vitek-2 Compact儀器及配套藥敏卡對菌株進(jìn)行鑒定及藥敏試驗(yàn),采用紙片擴(kuò)散法(Kirby-Bauer,K-B)測定頭孢哌酮/舒巴坦藥敏。同時對分離菌株患者的年齡、性別、科室及是否曾經(jīng)入住重癥監(jiān)護(hù)病房(Intensive care unit,ICU)進(jìn)行統(tǒng)計分析;采用脈沖場凝膠電泳(Pulsed Field Gel Electrophoresis,PFGE)技術(shù)對90株鮑曼不動桿菌進(jìn)行同源性分析;采用蹭行運(yùn)動、血凝和血凝抑制試驗(yàn)、生物膜形成和血清殺傷試驗(yàn)來檢測菌株毒力情況;采用聚合酶鏈反應(yīng)(Polymerase Chain Reaction,PCR)檢測D類碳青霉烯酶基因(blaOXA-23、24、51、58)和毒力基因(aba I、cus E、bap、bfm S、omp A)。結(jié)果(1)75株MDRAB多見于ICU病房,分離到49株,對頭孢哌酮/舒巴坦、阿米卡星及替加環(huán)素的敏感率較高分別為69.3%、77.3%和100.0%,對其它藥物的敏感率均較低,在30%以下。(2)脈沖場凝膠電泳結(jié)果顯示90株鮑曼不動桿菌分為21個克隆型,分別為A-U型,MDRAB見于A-H型,非MDRAB見于I-U型,兩者不存在相同克隆型別。MDRAB中A(n=51)和B(n=14)型為主要克隆型,不同醫(yī)院流行的克隆型不一樣,大部分醫(yī)院以A克隆型為主。(3)毒力表型試驗(yàn)結(jié)果顯示蹭行運(yùn)動能力1株陽性;未發(fā)現(xiàn)與O型紅細(xì)胞凝集的菌株,僅發(fā)現(xiàn)1株菌株在有無D-甘露糖存在條件下都與AB型的紅細(xì)胞凝集;生物被膜形成能力陽性57株,7株粘液型菌株全部陰性;血清殺傷能力試驗(yàn)有71株陽性。A克隆型生物膜形成能力強(qiáng)于B克隆型。(4)非粘液型菌株共83株,79.4%(n=54)的多重耐藥鮑曼不動桿菌毒力基因檢出全部陽性。多重耐藥鮑曼不動桿菌的aba I、bap、bfm S基因檢出率均高于非多重耐藥菌株。82.4%(n=42)的A克隆型菌株毒力基因檢出全部陽性。(5)90株鮑曼不動桿菌中有7株為粘液表型,均是MDRAB,均屬于B克隆型,且毒力基因檢出全部陽性。其中5株來自JL醫(yī)院,且抗菌藥物表型和脈沖場分型完全相同,表現(xiàn)出對頭孢哌酮/舒巴坦、左氧氟沙星、替加環(huán)素敏感,對其它抗生素均耐藥的表型。另外2株分別來自NJ醫(yī)院和TJ醫(yī)院,抗菌藥物表型與JL醫(yī)院的不同。結(jié)論本研究顯示臨床感染患者血液中分離的MDRAB對頭孢哌酮/舒巴坦、阿米卡星及替加環(huán)素耐藥率較低。我國不同地區(qū)血流感染患者血液中分離的MDRAB主要流行克隆型為A型,可能存在地區(qū)之間的播散現(xiàn)象,這可能是我國MDRAB分離率逐漸上升的原因,提示醫(yī)院應(yīng)加強(qiáng)院內(nèi)感染控制。A克隆性菌株生物膜膜形成能力強(qiáng),易在醫(yī)院環(huán)境中的生存和定植、導(dǎo)致菌株播散流行。多重耐藥菌株毒力基因檢出率高于非多重耐藥菌株,提示臨床在關(guān)注多重耐藥菌株時應(yīng)同時關(guān)注菌株的致病能力。粘液表型菌株可能具有更強(qiáng)的毒力并且易于播散,應(yīng)引起臨床的重視。
[Abstract]:Objective to collect the isolation of Acinetobacter Bauman from the blood of 17 clinical infection patients in the national teaching hospital, to determine its sensitivity to all kinds of common antibiotics, and to provide the basis for hospital infection control and clinical rational use of antibiotics, and to analyze the multidrug-resistant Acinetobacter (Multidrug-resistant Acinetobacte) of the national clinical epidemic strains (Multidrug-resistant Acinetobacte The homology of R baumannii, MDRAB (MDRAB) provides a basis for controlling the outbreak of multidrug-resistant Acinetobacter Bauman; the virulence phenotype test of 90 clinical strains of Acinetobacter Bauman, the distribution of virulence genes in all strains, and the correlation between virulence factor and drug resistance, virulence factor and homology, and clinical isolation The resistance, virulence and homology of 7 strains of mucous phenotype were analyzed. Methods a total of 90 strains of Acinetobacter Bauman were isolated from the blood samples from 17 teaching hospitals of China in July -2014 July 2013, including 75 multidrug-resistant strains and 15 non multidrug-resistant strains. The bacterial identification instrument Vitek-2 Compact instrument and the matching drug sensitive card were used to identify the strain and the drug sensitivity test. The drug sensitivity of Cefoperazone / sulbactam was measured by Kirby-Bauer (K-B). The age, sex, department and once the Intensive care unit (ICU) were analyzed and analyzed. Pulsed Field Gel Electrophoresis (PFGE) was used to analyze the homology of 90 Acinetobacter Bauman. The virulence of the strain was detected by rubbing movement, hemagglutination and hemagglutination test, biofilm formation and serum killing test, and the detection of D by polymerase chain reaction (Polymerase Chain Reaction, PCR). Carbapenem gene (blaOXA-23,24,51,58) and virulence genes (ABA I, cus E, BAP, BFM S, OMP A). Results (1) 75 MDRAB were found in ICU wards and separated to 49 strains. The sensitivity of Cefoperazone / sulbactam, Amikacin and tigastin was 69.3%, 77.3% and 100% respectively, and the sensitivity to other drugs was lower than 30%. (2) pulses. The results of field gel electrophoresis showed that 90 strains of Acinetobacter Bauman were divided into 21 clones, A-U type, MDRAB in A-H type, and non MDRAB in I-U type. There were no A (n=51) and B (n=14) type in the same clone.MDRAB as the main clones. The dominant clones in different hospitals were different. Most hospitals were dominated by A clone. (3) virulence phenotype. The test results showed that 1 strains of rubbing movement were positive. Only 1 strains were found to be agglutinated with AB type red blood cells under the presence of D- mannose, 57 strains positive for biofilm formation and 7 myxoid strains were negative, and 71 positive.A cloned biofilms were found in the blood clearance test. The formation ability was stronger than that of B clone. (4) 83 strains of non mucinous strain and 79.4% (n=54) of multidrug-resistant Acinetobacter Bauman were all positive. The detection rates of ABA I, BAP, BFM S in multiple drug resistant Acinetobacter spp. were all higher than those of non multidrug-resistant strain.82.4% (n=42) A cloned strain. (5) 90 strains 7 of the Acinetobacter of Acinetobacter sp., all of which are MDRAB, are MDRAB, all belong to B clone, and all of the virulence genes are positive. 5 of them are from JL hospital, and the phenotypes of antibacterial drugs and pulse field are exactly the same, showing the phenotype of Cefoperazone / sulbactam, levofloxacin, tegacycline sensitive, and other antibiotics. The 2 isolates from the NJ hospital and the TJ hospital were different from that of the JL hospital. Conclusion the study showed that the resistance rate of MDRAB to Cefoperazone / sulbactam, Amikacin and tegastin was low in the blood isolated from the patients with clinical infection. The major clone of MDRAB in the blood of patients with blood flow infection in different regions of our country was A type. There may be a phenomenon of spread between regions, which may be the cause of the gradual increase in the separation rate of MDRAB in China. It is suggested that the hospital should strengthen the hospital infection control of the membrane formation of the.A cloned strain, which is easy to survive and colonize in the hospital environment, and lead to the spread of the strain. The detection rate of virulence gene of multidrug resistant strains is higher than that of non multiple strains. Drug-resistant strains suggest that the pathogenicity of strains should be paid attention to at the same time when they are concerned with multidrug resistant strains. The mucous phenotypic strains may have stronger virulence and can be easily disseminated, and should be paid attention to.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R446.5;R515

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