泛耐药鲍曼不动杆菌医院获得性感染相关因素分析  

Correlation factor analysis of pan-drug resistant Acinetobacter baumannii strains in acquired infections

作　　者：黄髭飞[1] 王俊瑞[1] 顾海彤[1] 尚欣荣[1] 曹晶晶[1] 王玫[1] 范艳艳[1] 隋文君[1] 鲁辛辛[1] 

机构地区：[1]首都医科大学附属北京同仁医院检验科,100730

出　　处：《中华医学杂志》2011年第36期2525-2529,共5页National Medical Journal of China

基　　金：国家自然科学基金资助项目（30970126）

摘　　要：目的研究泛耐药鲍曼不动杆菌（PDRAB）医院获得性感染的临床因素、菌株耐药性与分子溯源，分析不同株系流行特征与感染相关因素。方法收集北京同仁医院2009年1月至2011年1月9次医院感染流行分离的PDRAB60株及临床资料；纸片琼脂扩散法检测其对12种抗生素的耐药表型；分别应用重复序列PCR（REP—PCR）和基质辅助激光解析电离飞行时间质谱仪（MALDI-TOF—TOFMS）对流行菌株进行基因水平和蛋白水平的溯源和鉴定。结果除2株菌对亚胺培南、美罗培南敏感外，其余抗生素均耐药。60株PDRABREP—PCR检测分为REP—A～L共12型，MALDI-TOF—TOFMS分为a～e5个类型。与MALDI—TOF—TOFMS相比，REP—PCR分型结果更为精细准确。呼吸机的携带与交叉传播可能是造成2009年7—10月呼吸科PDRAB大流行的主要原因；医护人员手传播是造成2010年1—2月外科重症监护病房PDRAB感染的关键因素；超级传播者鼻咽部或呼吸道PDRAB对周边环境的污染与传播是造成其余7次PDRAB流行的主要原因；急诊科是本院PDRAB获得性感染的传染源。结论早期识别和隔离超级传播者、加强环境器械消毒和医护人员手卫生、规范抗生素的使用是控制医院获得性感染的关键要素。MALDI—TOF—TOFMS方便、价廉、快速鉴定病原菌及分型优势有望成为微生物鉴定分型发展的方向。Objective To explore the clinical factors, drug resistance and molecular epidemiology homologous characteristics of pan-drug resistant Acinetobacter baumannii （PDRAB） in acquired infections and analyze the correlation factor between epidemic characteristics and acquired infections. Methods A total of 60 PDRAB strains from nine acquired infections and related clinic data were collected from January 2009 to January 2011. The drug-resistant phenotype was tested by disk diffusion methods. The isolate identification and homology were studied by automation repetitive-element sequence-based （REP）-PCR typing platform from genes and matrix-assisted laser desorption ionization-time of flight mass spectrometry （ MALDI-TOF-TOF MS） from proteins. Results All strains were resistant to 12 antibiotics except 2 strains to imipenem and meropenem. The strains in this study were divided into 12 types （A-L） by REP-PCR. And 60 strains were also clustered to a-e types by MALDI-TOF-TOF MS. Compared with MALDI-TOF-TOF MS, REP-PCR tended to be more accurate. Breathing machine carriage and cross transmission were the main reasons for a major epidemic outbreak at department of pulmonary medicine from July 2009 to October 2009. Hand transmission of medical care personnel was a key factor for SICU 2010 January to February. The contamination and transmission to environment of PDRAB in nasal pharynx or respiratory tract by superspreader were the main reasons for the other 7 epidemic outbreaks. Department of emergency medicine was the source of acquired infections. Conclusion The key control measures of acquired infections are early identification and isolation of spreader, environment and instrument disinfection, hand washing and rational uses of antibiotics. MALDI-TOF-TOF MS will become a preferred tool of identification and classification of microorganisms because of its simple operation, affordable price and handling rapidity.

关 键 词：鲍氏不动杆菌 交叉感染 自动化REP—PCR分型 基质辅助激光解析电离飞行时间质谱 

分 类 号：R47[医药卫生—护理学]