产金属β内酰胺酶铜绿假单胞菌呼吸机相关肺炎暴发临床分析  

Clinical analysis on an outbreak of ventilator-associated pneumonia caused by metallo-β-lactamase-producing Pseudomonas aeruginosa in respiratory intensive care unit

作　　者：赵子文[1] 钟维农[1] 马为[1] 叶惠芬[2] 齐晓红[3] 陈裕胜[1] 杨银梅[1] 熊剑辉[2] 

机构地区：[1]广州市第一人民医院呼吸内科,广东广州510180 [2]广州市第一人民医院细菌室,广东广州510180 [3]广州市第一人民医院感染科,广东广州510180

出　　处：《中国呼吸与危重监护杂志》2006年第3期168-171,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广东省自然科学基金资助(5000423)

摘　　要：目的探讨呼吸重症监护病房（RICU）产金属口内酰胺酶（MBLs）铜绿假单胞菌暴发流行的可能原因。方法对2002年1—4月RICU内6例行气管插管机械通气，并于支气管灌洗液中多次分离到多重耐药铜绿假单胞菌（MRPA）的呼吸机相关肺炎（VAP）病人进行调查。结果6例分离到的MRPA菌株MBLs阳性，经DNA分析为同一菌株暴发流行所致。其中4例死亡，2例好转。调查发现呼吸机出气口和湿化瓶有MRPA生长。结论产MBLs铜绿假单胞菌为泛耐药菌株，目前尚缺乏有效的治疗手段，在RICU内一旦出现，如不注意隔离，可造成该菌株的暴发流行。Objective To investigate an outbreak of ventilator-associated pneumonia （VAP） caused by metallo-β-lactamase（MBLs）-producing Pseudomonas aeruginosa in respiratory intensive care unit （RICU） in Guangzhou first people＇ s hospital. Methods The clinical, epidemiological and bacterial data of 6 cases with VAP caused by mulfidrug resistant Pseudomonas aeruginosa in the outbreak from Jan 2002 to Apr 2002 were retrospectively analysed. Results Six strains of muhidrug resistant Pseudomonas aeruginosa from 6 patients were shown to produce MBLs. These muhidrug resistant Pseudomonas aeruginosa were resistant to ciprofloxacin, cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, meropenem, imipenem, cefepime, piperacillin, amikacin, netilmicin, aztreonam and cefoperazone. Random amplified polymorphic DNA typing verified that the 6 strains had the same origination. Of 6 patients, 4 elder cases died, and 2 young cases survived.The same strain were also isolated from expiratory outlets and humidifiers of the respirators. Conchusions This MBLs-producing Pseudomonas aeruginosa is a pan-antibiotic resistant strain without effective treatment currently. Neglect of isolation and sterilzation could cause an outbreak of MBLs-producing mulfidrug resistant Pseudomonas aeruginosa in intensive care unit.

关 键 词：金属Β内酰胺酶 铜绿假单胞菌 呼吸机相关肺炎 

分 类 号：R563.1[医药卫生—呼吸系统] R978.11[医药卫生—内科学]