颅内感染的鲍曼不动杆菌耐药性与生物膜相关性分析

目的 分析某医院脑膜瘤术后颅内感染的患者中鲍曼不动杆菌（AB）的耐药性与生物膜的相关性。方法 选取2016年1 - 3月脑膜瘤切除术后颅内感染患者脑脊液中分离出的162株AB，采用梅里埃公司全自动微生物VITEK-2分析仪分离鉴定；体外药敏试验采用K-B纸片cc法；以96孔微孔板半定量法测定其生物膜形成能力，对比各类菌株的生物膜阳性率及生物表型分布情况；运用多重PCR技术对亚胺培南敏感和耐药的AB的相关特异基因进行分析。结果 162株AB中XDR、MDR的耐药率高达75.31%（122/162）；敏感组、MDR组、XDR组的AB中产生物膜率依次为24.70%、35.19%、40.12%。具有产生物膜能力且对亚胺培南敏感和耐药的AB的OXA-23、OXA-51、CarO、及AdeABC外排泵相关基因中，OXA-51、CarO均被检出，其表达无明显差异，其他基因的表达量差异有统计学意义（P＜0.05）。结论 OXA-23型AB是该院神经外科行脑膜瘤切除术后院内感染的重要病原菌之一，其生物膜的形成也影响着颅内感染AB的耐药性，临床应提高重视，合理使用抗菌药物。

Correlation analysis between drug resistance and biofilm of Acinetobacter baumannii in intracranial infection

Objective The aim of this study was to analyze the relationship between drug resistance and biofilm of Acinetobacter bauman (AB) in patients with intracranial infection after surgical removal of intracranial infection in a hospital department of neurosurgery. Methods A total of 162 strains of isolated AB from meningioma resection postoperative cerebrospinal fluid of patients with intracranial infection were selected in neurosurgery hospital from January to March 2016. Merieux Vitek automatic microbial Vitek-2 analyzer was used for isolation and identification. In vitro drug sensitivity test was performed by K-B method. 96 pore plate semi quantitative method was used to determine the biofilm forming ability, and was compared to various strains of biofilm positive rate and biological phenotype distribution. Multiplex PCR was used to analyze specific genes sensitive to imipenem and the resistance of the AB. Results The drug resistant rate achieved a highly level at 75.31% in 162 strains of AB (122/162). The biofilm positive rates of sensitive group, multiple drug resistance group and pan-drug resistance group were 24.70%, 35.19% and 40.12% respectively. Except that OXA-51 and CarO genes were expressed in both biofilm forming sensitive and resistance AB, the expression had no significant difference (P>0.05). The other genes' expression all had significant difference (P<0.05) among the OXA-23, OXA-51, Caro and AdeABC efflux pump related genes in biofilm forming sensitive and resistance AB. Conclusion OXA-23 type AB had become one of the most important pathogens for postoperative nosocomial infection in neurosurgery department of our hospital. Meningioma resection and the biofilm formation also affected the resistance of the AB intracranial infection, clinical practitioners should pay attention to the rational use of antimicrobial drugs.