从烧伤创面感染和呼吸机相关性肺炎感染分离出的菌株中D类碳青霉烯酶和超广谱β-内酰胺酶基因的分布情况
Distribution of Class D Carbapenemase and Extended-Spectrum β-Lactamase Genes among Isolated from Burn Wound and Ventilator Associated Pneumonia Infections.
作者信息
Mohammadi Maryam, Soroush Setareh, Delfani Somayeh, Pakzad Iraj, Abbaszadeh Abolfazl, Bahmani Mahmoud, Bogdanovic Lidija, Taherikalani Morovat
机构信息
Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
Razi Herbal Medicines Research Center, Department of Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
出版信息
J Clin Diagn Res. 2017 Jul;11(7):DC19-DC23. doi: 10.7860/JCDR/2017/25534.10218. Epub 2017 Jul 1.
INTRODUCTION
Resistance to is dramatically on the rise in Iran. Therefore, it is important to study resistance pattern among isolates which is a common cause of nosocomial infections.
AIM
To investigate antibiotic resistance patterns and the role of resistant genes and biofilm formation in the induction of resistance among isolated from burn wound and ventilator associated pneumonia infections.
MATERIALS AND METHODS
Total 103 isolates such as 33 burn samples from Rasool Akram Hospital and 70 isolates from ventilated patients in Shahid Motahhari Hospital were identified with . using biochemical method, and then identified to species level with PCR of and gene. Antibiotic sensitivity pattern for β-lactam and carbapenem antibiotics was assessed using Agar disc diffusion test and E-test. The presence of different carbapenemase and metalo-β-lactamase (, , , , , , , , , , ), extended-spectrum β-lactamases (, ) and two insertion sequences genes (, ) was assessed. Biofilm formation of all isolates was then assessed. Chi-square analysis or Fisher's-exact tests were used for statistical analysis. A p-value <0.05 was considered statistically significant.
RESULTS
Colistin was the most effective antimicrobial agents, although 10.7% (11/103) of the isolates were resistant. The high rate of resistance to meropenem (93.2%) and imipenem (90.3%) was determined. Also, with exception of ampicillin-sulbactam, surprisingly the resistant rate was 28.2%, the resistance to β-lactam antibiotic was dramatically increased. Co-existence of two and three blaOXA genes was also determined. The blaOXA-58 was detected in only one isolate. The blaTEM and blaOXA-23 was the most prevalent Extended-Spectrum β-Lactamases (ESBL) gene. All isolates were biofilm producers.
CONCLUSION
Antibiotic resistance is increasing among A. baumannii isolates which is due to excessive use of antibiotics and also acquired resistant genes and biofilm production. Resistance to nearly all antimicrobial agents especially colistin as end choice for treatment of multiple drug resistance A. baumannii is a big concern.
引言
在伊朗，对鲍曼不动杆菌的耐药性正在急剧上升。因此，研究鲍曼不动杆菌分离株的耐药模式很重要，因为它是医院感染的常见原因。
目的
调查从烧伤创面和呼吸机相关性肺炎感染中分离出的鲍曼不动杆菌的抗生素耐药模式以及耐药基因和生物膜形成在耐药诱导中的作用。
材料与方法
使用生化方法对总共103株分离株进行鉴定，其中包括拉苏勒·阿克拉姆医院的33份烧伤样本和沙希德·莫塔哈里医院呼吸机相关患者的70株分离株，然后通过16S rRNA和rpoB基因的PCR鉴定到种水平。使用琼脂纸片扩散试验和E试验评估β-内酰胺类和碳青霉烯类抗生素的药敏模式。评估不同碳青霉烯酶和金属β-内酰胺酶（NDM、VIM、IMP、KPC、OXA-23、OXA-24、OXA-48、OXA-51、OXA-58、OXA-181、OXA-204、SIM）、超广谱β-内酰胺酶（TEM、SHV）和两个插入序列基因（ISEcp1、ISCR1）的存在情况。然后评估所有分离株的生物膜形成情况。采用卡方分析或Fisher精确检验进行统计分析。p值<0.05被认为具有统计学意义。
结果
黏菌素是最有效的抗菌药物，尽管10.7%（11/103）的分离株耐药。确定了对美罗培南（93.2%）和亚胺培南（90.3%）的高耐药率。此外，除氨苄西林-舒巴坦外，令人惊讶的是耐药率为28.2%，对β-内酰胺类抗生素的耐药性显著增加。还确定了两个和三个blaOXA基因的共存情况。仅在一株分离株中检测到blaOXA-58。blaTEM和blaOXA-23是最常见的超广谱β-内酰胺酶（ESBL）基因。所有分离株均为生物膜产生菌。
结论
鲍曼不动杆菌分离株的抗生素耐药性正在增加，这是由于抗生素的过度使用以及获得性耐药基因和生物膜的产生。对几乎所有抗菌药物的耐药性，尤其是作为多重耐药鲍曼不动杆菌治疗最终选择的黏菌素，是一个重大问题。
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