重症监护病房耐亚胺培南鲍氏不动杆菌暴发流行病学研究  

Imipenem-resistant Acinetobacter baumannii Outbreak in Intensive Care Unit:A Survey of Epidemiology

作　　者：邹玖明[1] 李智山[1] 张爱平[2] 杨艳[1] 邓三季[1] 

机构地区：[1]华中科技大学同济医学院附属襄樊医院检验科,湖北襄樊441021 [2]襄樊市中心医院重症监护科,湖北襄樊441021

出　　处：《中华医院感染学杂志》2010年第18期2739-2741,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解医院重症监护病房(ICU)暴发流行耐亚胺培南鲍氏不动杆菌(ABA)的耐药机制,并对ICU进行了环境监测,以制定有效措施切断传播途径,控制暴发流行。方法 PCR扩增3种酶基因(OXA、IMP、VIM),对产物进行凝胶电泳和测序;对ICU环境进行采样监测;API20 NE鉴定菌株;纸片扩散法测定菌株对抗菌药物的敏感性,并与暴发流行菌株进行生物学类型及抗菌表型的比较。结果患者标本分离的10株耐亚胺培南ABA均携带OXA23基因,未检出IMP、VIM基因;40份监测样本中检出ABA15株,其他定植细菌13株,其中呼吸机分离的4株菌与流行菌株一致。结论携带OXA23基因是医院ABA耐碳青酶烯类药物的主要因素,环境污染对暴发流行有着重要的储菌作用,封闭病区、隔离患者、对病区全面消毒是控制暴发流行的根本措施。OBJECTIVE To understand the resistance mechanism of imipenem-resistant Acinetobacter baumannii（ABA） outbreak in intensive care unit（ICU） and make a survey of environmental contamination for making some useful measures to prevent the spread of infection and control such outbreaks.METHODS Three genes including OXA,IMP and VIM were amplified by polymerase chain reaction（PCR） and the products were sequenced by gel electrophoresis.Environmental contamination in ICU was investigated,ABA isolates were identified by API20 NE.Antibiotic susceptibility patterns were performed by disc diffusion technique.RESULTS PCR products of the appropriate size were obtained from ten isolates using primers for OXA23 gene,but no amplicons were obtained with primers targeting the IMP and VIM genes.Fifteen ABA strains and thirteen other colonized bacteria were isolated from forty environmental samples.Four ABA strains came from ventilator were indistinguishable.CONCLUSION Carrying with OXA-23 contributes to the imipenem-resistant ABA in ICU.Environmental contamination plays an important reservoir role in the outbreak.Closure of the wards,patients isolation and terminal disinfection to the wards are the fundamental measures to control such an outbreak.

关 键 词：重症监护病房 鲍氏不动杆菌 亚胺培南 耐药性 流行病学 

分 类 号：R378[医药卫生—病原生物学]