2023年至2024年新疆某三甲医院耐碳青霉烯类鲍曼不动杆菌的耐药性研究

doi:10.16150/j.1671-2870.2025.06.007

摘要/Abstract

摘要：

目的： 分析克拉玛依市中心医院2023年至2024年耐碳青霉烯类鲍曼不动杆菌（carbapenem resistant Acinetobacter baumannii，CRABA）的分子流行病学特征，了解CRABA碳青霉烯酶和耐药节结细胞分化家族[resistance-nodulation-cell division （family），RND]外排泵基因的携带情况，为新疆地区临床防控和治疗鲍曼不动杆菌感染提供实验依据。方法： 收集2023年至2024年克拉玛依市中心医院临床培养分离出的CRABA，计算鲍曼不动杆菌中检出CRABA的百分比（检出率）；采用PCR技术检测10种常见的碳青霉烯酶基因和RND外排泵基因。结果： 本研究检出179株CRABA，检出率为79.56%，主要检出科室为ICU（62.60%）和呼吸重症监护室（11.73%）。179株CRABA对抗菌药物的耐药率均较高，其中对环丙沙星的耐药率最高（100%），而对替加环素的耐药率最低（11.73%）。耐药基因检测结果显示，179株CRABA中阳性基因携带率从高到低分别为blaIMP 95.53%（171/179）、blaOXA-51 87.71%（157/179）、blaTEM 82.12%（147/179）、adeB 82.12%（147/179）、adeM 80.45%（144/179）、adeJ 77.65%（139/179）、blaOXA-23 74.86%（134/179）、blaNDM-1 8.94%（16/179）、blaOXA-58 4.47%（8/179）、blaVIM 0（0/179）。结论： 2023年至2024年，我院CRABA检出率高于全国平均水平（2023年，73.4%）；碳青霉烯酶基因blaIMP、blaTEM及RND外排泵基因adeB、adeM、adeJ的高表达，提示本地区临床应加强抗菌药物的管理，合理使用抗菌药物。

关键词: 耐碳青霉烯类鲍曼不动杆菌, 碳青霉烯酶, RND外排泵基因

Abstract:

Objective To analyze the molecular epidemiological characteristics of carbapenem-resistant Acinetobacter baumannii (CRABA) at Karamay Central Hospital from 2023 to 2024, and to investigate the carriage of carbape-nemase and RND efflux pump genes in CRABA, so as to provide an experimental basis for the clinical prevention, control, and treatment of Acinetobacter baumannii infection in the Xinjiang region. Methods CRABA strains isolated from clinical culture at Karamay Central Hospital from 2023 to 2024 were collected, and percentage of CRABA detected in Acinetobacter baumannii (detection rate) was calculated. PCR was used to detect 10 common carbapenemase genes and RND efflux pump genes. Results A total of 179 CRABA strains were obtained with a detection rate of 79.56%. The majority were detected in the ICU (62.60%) and the respiratory intensive care unit (11.73%). The strains showed high resistance rate to antibiotics, with the highest resistance rate observed for ciprofloxacin (100%), and the lowest for tigecycline (11.73%). The detection of drug resistance genes revealed that among the 179 CRABA strains, the positive carriage rates from high to low were: blaIMP 95.53% (171/179), blaOXA-51 87.71% (157/179), blaTEM 82.12% (147/179), adeB 82.12% (147/179), adeM 80.45% (144/179), adeJ 77.65% (139/179), blaOXA-23 74.86% (134/179), blaNDM-1 8.94% (16/179), blaOXA-58 4.47% (8/179), and blaVIM 0 (0/179). Conclusions The detection rate of CRABA at our hospital from 2023 to 2024 were significantly higher than the national average (2023, 73.4%). The high expression of the carbapenemase genes include blaIMP and blaTEM, and RND efflux pump genes adeB, adeM, and adeJ. This suggests that local clinical practice should strengthen the management of antibiotics and ensure their rational use.

Key words: Carbapenem-resistant Acinetobacter baumannii, Carbapenemase, RND efflux pump genes

中图分类号:

R372
R451

贾丽影, 许海峰, 于冲, 郭万海, 龙锐. 2023年至2024年新疆某三甲医院耐碳青霉烯类鲍曼不动杆菌的耐药性研究[J]. 诊断学理论与实践, 2025, 24(06): 621-627.

JIA Liying, XU Haifeng, YU Chong, GUO Wanhai, LONG Rui. Study on drug resistance of carbapenem-resistant Acinetobacter baumannii in a tertiary hospital in Xinjiang from 2023 to 2024[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(06): 621-627.

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参考文献 30

[1]	张瑞凌, 冼盈, 张扣兴. 鲍曼不动杆菌感染与免疫研究进展[J]. 中国感染与化疗杂志, 2017, 17(2):224-228.
	ZHANG R L, XIAN Y, ZHANG K X. Research advances in Acinetobacter baumannii infection and host immunity[J]. Chin J Infect Chemother, 2017, 17(2):224-228.
[2]	JAMAL S, AL ATROUNI A, RAFEI R, et al. Molecular mechanisms of antimicrobial resistance in Acinetobacter baumannii, with a special focus on its epidemiology in Lebanon[J]. J Glob Antimicrob Resist, 2018, 15:154-163. doi: S2213-7165(18)30106-1 pmid: 29859266
[3]	郭燕, 胡付品, 朱德妹, 等. 2023年CHINET中国细菌耐药监测[J]. 中国感染与化疗杂志, 2024, 24(6):627-637. doi: 10.16718/j.1009-7708.2024.06.001
	GUO Y, HU F P, ZHU D M, et al. Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Antimicrobial Resistance Surveillance Program,2023[J]. Chin J Infect Chemother, 2024, 24(6):627-637.
[4]	BOYLE D P, ZEMBOWER T R. Epidemiology and mana-gement of emerging drug-resistant gram-negative bacteria: extended-spectrum β-lactamases and beyond[J]. Urol Clin North Am, 2015, 42(4):493-505. doi: 10.1016/j.ucl.2015.05.005 URL
[5]	RANJBAR R, FARAHANI A. Study of genetic diversity, biofilm formation, and detection of carbapenemase, MBL, ESBL, and tetracycline resistance genes in multidrug-resistant Acinetobacter baumannii isolated from burn wound infections in Iran[J]. Antimicrob Resist Infect Control, 2019, 8:172. doi: 10.1186/s13756-019-0612-5
[6]	刘秋萍, 徐凌. 鲍曼不动杆菌耐药机制的研究进展[J]. 中国抗生素杂志, 2018, 43(10):1179-1187.
	LIU Q P, XV L. Advances in resistance mechanisms of drug-resistant Acinetobacter baumannii[J]. Chin J Antibiot, 2018, 43(10):1179-1187.
[7]	周亚玲, 阴晴, 王中新. 鲍曼不动杆菌碳青霉烯酶和RND外排泵相关耐药基因的研究[J]. 国际检验医学杂志, 2021, 42(21):2635-2639.
	ZHOU Y L, YIN Q, WANG Z X. Study on carbapenemase and RND efflux pump related drug resistance genes in Acinetobacter baumannii[J]. Int J Lab Med, 2021, 42(21):2635-2639.
[8]	ABOUELFETOUH A, TORKY A S, ABOULMAGD E. Phenotypic and genotypic characterization of carbapenem-resistant Acinetobacter baumannii isolates from Egypt[J]. Antimicrob Resist Infect Control, 2019, 8:185. doi: 10.1186/s13756-019-0611-6
[9]	BAGHERI JOSHEGHANI S, MONIRI R, FIROOZEH F, et al. Susceptibility pattern and distribution of oxacilli-nases and bla PER-1 Genes among multidrug resistant Acinetobacter baumannii in a teaching hospital in Iran[J]. J Pathog, 2015, 2015:957259.
[10]	ZHAO S Y, JIANG D Y, XU P C, et al. An investigation of drug-resistant Acinetobacter baumannii infections in a comprehensive hospital of East China[J]. Ann Clin Microbiol Antimicrob, 2015, 14:7. doi: 10.1186/s12941-015-0066-4 URL
[11]	HOU P F, CHEN X Y, YAN G F, et al. Study of the correlation of imipenem resistance with efflux pumps AdeABC, AdeIJK, AdeDE and AbeM in clinical isolates of Acinetobacter baumannii[J]. Chemotherapy, 2012, 58(2):152-158. doi: 10.1159/000335599 URL
[12]	陈娇, 刘康, 李剑平, 等. 鲍曼不动杆菌RND主动外排泵的表达与耐药性的关系[J]. 中国感染控制杂志, 2018, 17(11):951-957.
	CHEN J, LIU K, LI J P, et al. Relationship between expression and antimicrobial resistance of RND efflux pump of Acinetobacter baumannii[J]. Chin J Infect Control, 2018, 17(11):951-957.
[13]	CHEN Y, ZHOU Z, JIANG Y, et al. Emergence of NDM-1-producing Acinetobacter baumannii in China[J]. J Antimicrob Chemother, 2011, 66(6):1255-1259. doi: 10.1093/jac/dkr082 URL
[14]	朱秋丽, 卫菊, 胡丹, 等. 耐碳青霉烯类鲍曼不动杆菌下呼吸道感染的危险因素研究[J]. 中国消毒学杂志, 2019, 36(5):359-361,364. doi: 10.11726/j.issn.1001-7658.2019.05.013
	ZHU Q L, WEI J, HU D, et al. Risk factors of carbape-nem-resistant Acinetobacter baumannii infection in low respiratory tract[J]. Chin J Disinfection, 2019, 36(5):359-361,364.
[15]	习慧明, 徐英春, 朱德妹, 等. 2010年中国CHINET鲍曼不动杆菌耐药性监测[J]. 中国感染与化疗杂志, 2012, 12(2):98-104.
	XI H M, XV Y C, ZHU D M, et al. CHINET 2010 surveillance of antibiotic resistance in Acinetobacter baumannii in China[J]. Chin J Infect Chemother, 2012, 12(2):98-104.
[16]	张辉, 张小江, 徐英春, 等. 2011年中国CHINET不动杆菌属细菌耐药性监测[J]. 中国感染与化疗杂志, 2013, 13(5):342-348.
	ZHANG H, ZHANG X J, XV Y C, et al. CHINET 2011 surveillance of antibiotic resistance in A.baumannii isolates in China[J]. Chin J Infect Chemother,2013, 13(5):342-348.
[17]	陈鹏. 鲍曼不动杆菌耐药机制的研究进展[J]. 医学综述, 2012, 18(15):2463-2466.
	CHEN P. Research advances in drug resistance mechanism of Acinetobacter baumannii[J]. Med Recapitulate, 2012, 18(15):2463-2466.
[18]	韩燕霞, 白海, 哈小琴, 等. 2015-2017年某院鲍曼不动杆菌临床分布及耐药性分析[J]. 国际检验医学杂志, 2018, 39(20):2556-2559.
	HAN Y X, BAI H, HA X Q, et al. Analysis of clinical distribution and drug resistance of Acinetobacter baumannii in a hospital from 2015 to 2017[J]. Int J Lab Med, 2018, 39(20):2556-2559.
[19]	周华, 周建英, 俞云松. 中国鲍曼不动杆菌感染诊治与防控专家共识解读[J]. 中国循证医学杂志, 2016, 16(1):26-29.
	ZHOU H, ZHOU J Y, YÜ Y S. The interpretation of chinese expert consensus for the diagnosis, treatment, prevention and control of Acinetobacter Baumannii infection[J]. Chin J Evid-based Med, 2016, 16(1):26-29.
[20]	蔡果果. 耐碳青霉烯类鲍曼不动杆菌耐药机制及治疗研究进展[J]. 现代医药卫生, 2019, 35(2):234-237.
	CAI G G, WANG C Y. Research progress on drug resistance mechanism and treatment of carbapenem resistant Acinetobacter baumannii[J]. Modern Med Health, 2019, 35 (2): 234-237.
[21]	陈志勇, 袁学刚, 喻军华. 腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的疗效和安全性[J]. 中国临床研究, 2023, 36 (7): 1038-1042.
	CHEN ZY, YUAN XG, YU JH. The efficacy and safety of lumbar cistern drainage combined with intrathecal injection in treatment of pan-durg resistant Acinetobacter baumannii intracranial infection[J]. Chin J Clin Res,2023,36(7):1038-1042.
[22]	毛炜, 黄春华, 方英, 等. 四川省简阳市院感鲍曼不动杆菌耐药性及同源性溯源研究[J]. 中国热带医学, 2023, 23(1):44-48.
	MAO W, HUANG C H, FANG Y, et al. Value of drug resistance and homology of Acinetobacter baumannii in tracing the source of nosocomial infection in Jianyang,Sichuan[J]. Chin Trop Med, 2023, 23(1):44-48.
[23]	丁梦珊, 蔡蕊, 花璇, 等. 耐碳青霉烯类鲍曼不动杆菌碳青霉烯酶耐药基因及整合子检测与分析[J]. 临床检验杂志, 2016, 34(10):795-797.
	DING M S, CAI R, HUA X, et al. Detection and analysis of carbapenemase resistance genes and integrons in carbapenem resistant Acinetobacter baumannii strains[J]. Chin J Clin Lab Sci, 2016, 34(10):795-797.
[24]	邓德耀, 袁文丽, 刘春林. OXA-51型β内酰胺酶的研究进展[J]. 中国感染与化疗杂志, 2014, 14(5):451-454.
	DENG D Y, YUAN W L, LIU C L. Research update on OXA-51 β-lactamase[J]. Chin J Infect Chemother, 2014, 14(5):451-454.
[25]	BORAL B, UNALDI Ö, ERGIN A, et al. A prospective multicenter study on the evaluation of antimicrobial resistance and molecular epidemiology of multidrug-resistant Acinetobacter baumannii infections in intensive care units with clinical and environmental features[J]. Ann Clin Microbiol Antimicrob, 2019, 18(1):19. doi: 10.1186/s12941-019-0319-8
[26]	陈荣忠, 杨子依, 向蓉. 鲍曼不动杆菌耐药性与外排泵基因、外膜孔蛋白基因的相关性研究[J]. 国际检验医学杂志, 2022, 43(24):2969-2972,2976.
	CHEN R Z, YANG Z Y, XIANG R. Study on correlation between drug resistance of Acinetobacter baumannii with efflux pump gene and outer membrane porin gene[J]. Int J Lab Med, 2022, 43(24):2969-2972,2976.
[27]	程建军, KESAVAN DINESH KUMAR, 阴晴, 等. 鲍曼不动杆菌分子特征及其在替加环素压力下外排泵表达的变化[J]. 医学研究生学报, 2020, 33(1):18-24.
	CHEN J J, KESAVAN DINESH KUMAR, YIN Q, et al. Molecular characteristics of Acinetobacter baumannii and the changes of efflux pump expression under tigecycline pressure[J]. J Med Postgra, 2020, 33(1):18-24.
[28]	MORGAN C E, ZHANG Z, BONOMO R A, et al. An analysis of the novel fluorocycline TP-6076 bound to both the ribosome and multidrug efflux pump AdeJ from Acinetobacter baumannii[J]. mBio, 2021, 13(1):e0373221.
[29]	廖佳馨, 胡韦维. 群体感应系统信号分子受体abaR基因对鲍曼不动杆菌致病性和获得性耐药的影响[J]. 重庆医科大学学报, 2025, 50(1):52-57.
	LIAO J X, HU W W. Effect of the quorum sensing system LuxR type regulator abaR on the pathogenicity and drug resistance of Acinetobacter baumannii[J]. J Chongqing Med Univ, 2025, 50(1):52-57
[30]	陈志勇, 袁学刚, 喻军华. 腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的疗效和安全性[J]. 中国临床研究, 2023, 36(7):1038-1042.
	CHEN Z Y, YUAN X G, YU J H. The efficacy and safety of lumbar cistern drainage combined with intrathecal injection in treatment of pan-drug resistant Acinetobacter baumannii intracranial infection[J]. Chin J Clin Res, 2023, 36 (7): 1038-1042.

Gene name	Primer sequences(5´→3´)	Length(bp)
Carbapenemase gene
blaTEM	F：ATCAGCAATAAACCAGC	522
blaTEM	R：CCCCGAAGAACGTTTTC	522
blaNDM-1	F：CTCGCACCGAATGTCTGG	713
blaNDM-1	R：CATTGGCGGCGAAAGTCA	713
blaVIM	F：GTTTGGTCGCATATCGCAAC	278
blaVIM	R：AATGCGCAGCACCAGGATAG	278
blaIMP	F：CATGGTTTGGTGGTTCTTGT	524
blaIMP	R：AATATTTTGGCGGACTTTGGC	524
blaOXA-23	F：GATCGGATTGGAGAACCAGA	517
blaOXA-23	R：ATTTCTGACCGCATTTCCAT	517
blaOXA-51	F：TAATGCTTTGATCGGCCTGG	367
blaOXA-51	R：TGGATTGCACTTCATCTTGG	367
blaOXA-58	F：AAGTATTGGGGCTTGTGCTG	603
blaOXA-58	R：CCCCTCTGCGCTCTACATAC	603
RND efflux pump gene
adeB	F：TGGCGGAATGAAGTATGT	885
adeB	R：GCAGTGCGGCAGGTTAG	885
adeM	F：GTAGGTGTAGGCTTATGGA	687
adeM	R：GTACCGAAGTGACTGAAAT	687
adeJ	F：TTAACGATAGCGTTGTAACC	481
adeJ	R：TGAGCAGACAATGGAATAGT	481

Year	Pathogenic bacteria (N)	Acinetobacter baumannii (n)	CRABA(n)	Percentage of CRABA accounting for Acinetobacter baumannii （%）
2023	2 272	101	81	80.20
2024	3 652	124	98	79.03
Total	5 924	225	179	79.56

Specimen source	Number	Percentage（%）
Sputum	146	81.56
Throat swab	10	5.59
Bronchial aspirate	7	3.91
Blood	6	3.35
Secretion	5	2.79
Urine	2	1.12
Bile	2	1.12
Pus	1	0.56
Total	179	100

Specimen source	Number	Percentage（%）
Intensive care unit	112	62.60
Respiratory intensive care unit	21	11.73
Neurological intensive care unit	16	8.94
Respiratory department	12	6.70
Neurology	3	1.68
Neurosurgery	2	1.12
Emergency Department	2	1.12
General foreign language one	2	1.12
Urology	2	1.12
Burn department	1	0.56
Coronar/Care unit	1	0.56
Infection department	1	0.56
Nephrology department	1	0.56
Gastroenterology department	1	0.56
Rehabilitation department	1	0.56
Orthopaedics	1	0.56
Total	179	100

Antibiotic name	Number	Percentage（%）
Compound sulfamethoxazole	46	25.70
Ceftazidime	177	98.88
Cefepime	175	97.77
Piperacillin tazobactam	177	98.88
Cefoperazone and sulbactam	109	60.89
Imipenem	179	100
Meropenem	179	100
Doxycycline	91	50.84
Minocycline	97	54.19
Tobramycin	126	70.39
Levofloxacin	136	75.98
Ciprofloxacin	179	100
Tigecycline	21	11.73