Clinical Separated Acinetobacter Baumannii Strains Of Pathogenic Bacteria Of The Determination Of Drug Sensitivity And The Preliminary Exploration Of Resistance Mechanisms Of Tigecycline

Objective: Understand our 242 strains of clinical separated acinetobacter baumannii infection in patients with clinical features,testing its susceptibility to common antimicrobial agents,detection of efflux pump gene distribution and the level of part of efflux pump gene expression asain acinetobacter baumannii resistance and the mechanism of tigecycline.Methods: Collection of north sichuan medical college affiliated hospital between September 2015 and September 2015 training to acinetobacter baumannii strains and related clinical data,using the K-B method for drug susceptibility test in vitro,and the PCR to adeB adeG,adeJ,adeR,adeS,adeE,abe M,tetA,tetB,abe S efflux pump,such as genetic testing,to check out at the same time,adeB adeG,adeJ,abeM strains are divided into according to antimicrobial susceptibility test of tigecycline to sensitive and resistant group,using the method of q PCR detection adeB,adeG,adeJ,abeM expression quantity and comparison.Results: 1.242 clinical separated acinetobacter baumannii strains from sputum specimens up to 181 strains(74.79%),followed by the pus 41 strains(16.94%).Distribution department top three,respectively is: the ICU(45.04%),nerve surgery(19.01%)and respiratory medicine(18.18%).138 cases according to male,female 104 cases;At the age of 70 or higher in 157 patients,50 to 70 year – old 64 cases;Combined craniocerebral disease the most,with65 cases(26.86%),combination of COPD,diabetes,cardiovascular disease,there were 56 patients(23.14%),46 cases(19.00%),42 cases(17.36%).Combination of organ failure conditions: 101 cases with respiratory failure(41.73%),heart failure 39 cases(16.11%),renal failure(6.20%).The use of antimicrobial agents: II drugs accounted for 60.74%(147/242),I use accounted for 25.62%(62/242),III and above drugs accounted for 13.64%(33/242);Used more than 3 kinds of antibiotics at hospitalization 149 patients(61.57%),penicillium used carbon alkene class of antibiotics 87 patients(35.95%);Artificial airway or mechanical ventilation 62%;Invasive operators accounted for 86.78%;Prognosis: no significant improvement or death during the period of hospitalization in 92 patients(38.02%).The average hospitalization days of 46.2 days.2.Acinetobacter baumannii cefoperazone/sulbactam,meropenem,mipenerm,tigecycline< 50%,respectively 45.04%,29.75%,27.27% and3.31%;Cefepime,ceftriaxone,cefotaxime,cefazolin he totally resistant rate respectively were 75.21%,73.55%,71.07%,66.53%;To streptomycin,gentamicin,ampicillin/ sulbactam,and piperacillin/tazobactam,ciprofloxacin,levofloxacin,amikacin resistant rate: 87.60%,83.06%,78.10%,77.69%,77.69%,66.12%,65.29%.3.From 242 strains of acinetobacter baumannii efflux pump gene,ade B,adeG,adeJ,adeR,adeS,adeE,abe M,tetA,tetB,abeS detection rate is respectively: 81.82%,85.95%,83.47%,81.00%,83.47%,0%,80.58%,21.49%,80.58% and 100%.To simultaneously detect adeB,adeG,adeJ,abeM genetic element tigecycline drug-resistant strains or not divided into sensitive and resistant group,testing the expression of adeB,adeG,adeJ,abe M,and carries on the comparison,the result shows: the adeB,adeG,ade J,abeM the expression of amount in the resistant group: sensitive group respectively: 21 times,1,5 times,twice.Conclusion: 1.Our distribution mainly in the ICU acinetobacter baumannii strains,followed by neurology,respiratory medicine,mainly from the sputum,infection were generally older age,with basic diseases and more heavy,hospitalization antibiotic use variety,common combination phenomenon,in the majority with lung infection,prone to respiratory failure and invasive operation and surgery might be the risk factors of acinetobacter baumannii infection.2.Our clinical separated acinetobacter baumannii cefepime,ceftriaxone,cefotaxime,cefazolin he organism resistance to high,to cefoperazone,meropenem,mipenerm,cefoperazone/sulbactam,carbon alkene antimicrobial agents,such as meropenem,mipenerm more sensitive,penicillium carbon alkene antibiotics,tigecycline can be used as a drug of choice for clinical treatment.3.The test of acinetobacter baumannii RND(adeABC adeFGH adeIJK)efflux pump gene detection rate is generally high,and drug resistance detection rate is higher than sensitive group,difference was statistically significant,so the acinetobacter baumannii on antimicrobial resistance may mainly by RND efflux pump mediated;AdeE detection rate of 0,prove our acinetobacter baumannii may not exist adeE efflux pump genetic epidemic.4.High expression of efflux pump adeABC,adeIJK mediated our acinetobacter baumannii to add ring element for drug resistance,is an important drug resistance mechanism,and efflux pump adeFGH and abeM(MATE efflux pump system)is mediated our acinetobacter baumannii to resistance of tigecycline to expand further study.