目的 分析住院患儿临床分离的耐碳青霉烯类鲍曼不动杆菌（carbapenem-resistant Acinetobacter baumannii, CRAB）的分布、耐药及生物膜特征，为住院患儿CRAB感染的防治提供参考。 方法 通过重复回文序列聚合酶链反应将2019年1月—2022年12月分离的48株CRAB分为流行株及散发株，比较这两类菌株耐药及生物膜表型及基因携带情况。 结果 22株流行株及26株散发株均表现为产D类碳青霉烯酶或产结合下调膜孔蛋白的广谱β-内酰胺酶，且均携带VIM、OXA-23、OXA-51基因。散发株生物膜形成能力强于流行株（P<0.05）。流行株及散发株中均检出生物膜相关Bap、bfs、OmpA、CsuE、intI1基因，其中intI1基因在流行株中的检出率高于散发株（P<0.05）。 结论 CRAB菌株在医院存在定植，散发株有较强的生物膜形成能力，具备在医院环境中形成新的克隆传播的可能。因此，有必要持续监测CRAB的流行趋势，预警流行株的分布，以降低住院患儿感染CRAB的风险。
Abstract
Objective To study the distribution, drug resistance, and biofilm characteristics of carbapenem-resistant Acinetobacter baumannii (CRAB) isolated from hospitalized children, providing a reference for the prevention and treatment of CRAB infections in hospitalized children. Methods Forty-eight CRAB strains isolated from January 2019 to December 2022 were classified into epidemic and sporadic strains using repetitive extragenic palindromic sequence-based polymerase chain reaction. The drug resistance, biofilm phenotypes, and gene carriage of these two types of strains were compared. Results Both the 22 epidemic strains and the 26 sporadic strains were producers of Class D carbapenemases or extended-spectrum β-lactamases with downregulated outer membrane porins, harboring the VIM, OXA-23, and OXA-51 genes. The biofilm formation capability of the sporadic strains was stronger than that of the epidemic strains (P<0.05). Genes related to biofilm formation, including Bap, bfs, OmpA, CsuE, and intI1, were detected in both epidemic and sporadic strains, with a higher detection rate of the intI1 gene in epidemic strains (P<0.05). Conclusions CRAB strains are colonized in the hospital, with sporadic strains having a stronger ability to form biofilms, suggesting the potential for forming new clonal transmissions in the hospital. Continuous monitoring of the epidemic trends of CRAB and early warning of the distribution of epidemic strains are necessary to reduce the risk of CRAB infections in hospitalized children.
关键词
鲍曼不动杆菌 /
碳青霉烯酶 /
生物膜 /
儿童
Key words
Acinetobacter baumannii /
Carbapenemase /
Biofilm /
Child
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参考文献
1 Antunes LC, Visca P, Towner KJ. Acinetobacter baumannii: evolution of a global pathogen[J]. Pathog Dis, 2014, 71(3): 292-301. PMID: 24376225. DOI: 10.1111/2049-632X.12125.
2 付盼, 王传清, 俞蕙, 等. 中国儿童细菌耐药监测组2021年儿童细菌耐药监测[J]. 中国循证儿科杂志, 2022, 17(5): 355-362. DOI: 10.3969/j.issn.1673-5501.2022.05.006.
3 CHINET中国细菌耐药监测网. 鲍曼不动杆菌对亚胺培南和美罗培南的耐药变迁[EB/OL]. [2023-09-03]. http://www.chinets.com/Data/GermYear.
4 许彩芳, 许巍. 儿童鲍曼不动杆菌感染及抗生素选择现状研究进展[J]. 中国小儿急救医学, 2019, 26(10): 771-776. DOI: 10.3760/cma.j.issn.1673-4912.2019.10.011.
5 Aliramezani A, Douraghi M, Hajihasani A, et al. Clonal relatedness and biofilm formation of OXA-23-producing carbapenem resistant Acinetobacter baumannii isolates from hospital environment[J]. Microb Pathog, 2016, 99: 204-208. PMID: 27569533. DOI: 10.1016/j.micpath.2016.08.034.
6 Roy S, Chowdhury G, Mukhopadhyay AK, et al. Convergence of biofilm formation and antibiotic resistance in Acinetobacter baumannii infection[J]. Front Med (Lausanne), 2022, 9: 793615. PMID: 35402433. PMCID: PMC8987773. DOI: 10.3389/fmed.2022.793615.
7 Koeleman JG, van der Bijl MW, Stoof J, et al. Antibiotic resistance is a major risk factor for epidemic behavior of Acinetobacter baumannii[J]. Infect Control Hosp Epidemiol, 2001, 22(5): 284-288. PMID: 11428438. DOI: 10.1086/501901.
8 Luo TL, Rickard AH, Srinivasan U, et al. Association of blaOXA-23 and bap with the persistence of Acinetobacter baumannii within a major healthcare system[J]. Front Microbiol, 2015, 6: 182. PMID: 25814985. PMCID: PMC4357298. DOI: 10.3389/fmicb.2015.00182.
9 Vila J, Marcos MA, Jimenez de Anta MT. A comparative study of different PCR-based DNA fingerprinting techniques for typing of the Acinetobacter calcoaceticus-A. baumannii complex[J]. J Med Microbiol, 1996, 44(6): 482-489. PMID: 8636966. DOI: 10.1099/00222615-44-6-482.
10 喻华, 徐雪松, 李敏, 等. 肠杆菌目细菌碳青霉烯酶的实验室检测和临床报告规范专家共识（第二版）[J]. 中国感染与化疗杂志, 2022, 22(4): 463-474. DOI: 10.16718/j.1009-7708.2022.04.014.
11 Abouelfetouh A, Torky AS, Aboulmagd E. Phenotypic and genotypic characterization of carbapenem-resistant Acinetobacter baumannii isolates from Egypt[J]. Antimicrob Resist Infect Control, 2019, 8: 185. PMID: 31832185. PMCID: PMC6868752. DOI: 10.1186/s13756-019-0611-6.
12 Stepanovi? S, Vukovi? D, Hola V, et al. Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci[J]. APMIS, 2007, 115(8): 891-899. PMID: 17696944. DOI: 10.1111/j.1600-0463.2007.apm_630.x.
13 陈金莲, 刘泉波. 某儿童医院鲍曼不动杆菌的临床来源特点及耐药性分析[J]. 中国抗生素杂志, 2023, 48(5): 573-578. DOI: 10.3969/j.issn.1001-8689.2023.05.013.
14 Ziegler KM, Haywood JD, Sontag MK, et al. Application of the new centers for disease control and prevention surveillance criteria for ventilator-associated events to a cohort of PICU patients identifies different patients compared with the previous definition and physician diagnosis[J]. Crit Care Med, 2019, 47(7): e547-e554. PMID: 30985451. PMCID: PMC7089756. DOI: 10.1097/CCM.0000000000003766.
15 葛艳玲, 单庆文, 邱悦, 等. 儿童侵袭性鲍曼不动杆菌感染的危险因素和耐药模式分析[J]. 中华儿科杂志, 2022, 60(8): 762-768. PMID: 35922185. DOI: 10.3760/cma.j.cn112140-20220502-00404.
16 曹静平, 景春梅. 儿童感染碳青霉烯类耐药鲍曼不动杆菌耐药性及耐药基因型分析[J]. 重庆医学, 2019, 48(20): 3503-3506. DOI: 10.3969/j.issn.1671-8348.2019.20.020.
17 Zhu Y, Zhang X, Wang Y, et al. Insight into carbapenem resistance and virulence of Acinetobacter baumannii from a children's medical centre in eastern China[J]. Ann Clin Microbiol Antimicrob, 2022, 21(1): 47. PMID: 36335338. PMCID: PMC9637306. DOI: 10.1186/s12941-022-00536-0.
18 Wang X, Du Z, Huang W, et al. Outbreak of multidrug-resistant Acinetobacter baumannii ST208 producing OXA-23-like carbapenemase in a children's hospital in Shanghai, China[J]. Microb Drug Resist, 2021, 27(6): 816-822. PMID: 33185494. DOI: 10.1089/mdr.2019.0232.
19 宋志伟, 俞莲花, 蔡艳群, 等. 耐碳青霉烯类鲍氏不动杆菌的耐药基因检测及流行病学分析[J]. 中华医院感染学杂志, 2017, 27(2): 255-258. DOI: 10.11816/cn.ni.2017-162713.
20 Héritier C, Poirel L, Lambert T, et al. Contribution of acquired carbapenem-hydrolyzing oxacillinases to carbapenem resistance in Acinetobacter baumannii[J]. Antimicrob Agents Chemother, 2005, 49(8): 3198-3202. PMID: 16048925. PMCID: PMC1196226. DOI: 10.1128/AAC.49.8.3198-3202.2005.
21 范学财, 郭朝阳, 郭宇航, 等. 耐碳青霉烯类鲍曼不动杆菌OXA-23-like基因的克隆和表达[J]. 基因组学与应用生物学, 2020, 39(3): 1331-1336. DOI: 10.13417/j.gab.039.001331.
22 Lee YT, Kuo SC, Chiang MC, et al. Emergence of carbapenem-resistant non-baumannii species of Acinetobacter harboring a blaOXA-51-like gene that is intrinsic to A. baumannii[J]. Antimicrob Agents Chemother, 2012, 56(2): 1124-1127. PMID: 22083478. PMCID: PMC3264228. DOI: 10.1128/AAC.00622-11.
23 Yin W, Wang Y, Liu L, et al. Biofilms: the microbial "protective clothing" in extreme environments[J]. Int J Mol Sci, 2019, 20(14): 3423. PMID: 31336824. PMCID: PMC6679078. DOI: 10.3390/ijms20143423.
24 魏兰芬, 潘协商, 张磊, 等. 建立鲍曼不动杆菌生物膜合成相关基因信息分析及PCR检测方法[J]. 中国消毒学杂志, 2011, 28(4): 414-417.
25 Goh HM, Beatson SA, Totsika M, et al. Molecular analysis of the Acinetobacter baumannii biofilm-associated protein[J]. Appl Environ Microbiol, 2013, 79(21): 6535-6543. PMID: 23956398. PMCID: PMC3811493. DOI: 10.1128/AEM.01402-13.
26 Khoshnood S, Savari M, Abbasi Montazeri E, et al. Survey on genetic diversity, biofilm formation, and detection of colistin resistance genes in clinical isolates of Acinetobacter baumannii[J]. Infect Drug Resist, 2020, 13: 1547-1558. PMID: 32547124. PMCID: PMC7266307. DOI: 10.2147/IDR.S253440.
27 韩欣欣, 李庆淑, 申丽婷, 等. 鲍曼不动杆菌生物膜形成能力与生物膜相关基因及耐药性之间的关系[J]. 中华危重病急救医学, 2014, 26(9): 639-643. PMID: 25230865. DOI: 10.3760/cma.j.issn.2095-4352.2014.09.007.
28 Kishii K, Hamada M, Aoki K, et al. Differences in biofilm formation and transcription of biofilm-associated genes among Acinetobacter baumannii clinical strains belonging to the international clone II lineage[J]. J Infect Chemother, 2020, 26(7): 693-698. PMID: 32249162. DOI: 10.1016/j.jiac.2020.02.017.
29 Al-Shamiri MM, Zhang S, Mi P, et al. Phenotypic and genotypic characteristics of Acinetobacter baumannii enrolled in the relationship among antibiotic resistance, biofilm formation and motility[J]. Microb Pathog, 2021, 155: 104922. PMID: 33932545. DOI: 10.1016/j.micpath.2021.104922.
基金
昆医联合专项-面上项目（202301AY070001-172）；昆明市卫生健康委员会卫生科研课题项目（2022-11-01-009）；昆明市卫生科技人才培养项目［2022-SW（后备）-50］；昆明市“春城计划”青年人才专项。
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