引发重症监护室内血流感染的粘质沙雷菌同源性分析  

Homology analysis of Serratia marcescens strains causing blood stream infection in an intensive care unit

作　　者：陈炜[1] 甄国东 赵琼[1] 邓梅[1] 毕晟[1] 盛吉芳[1] 

机构地区：[1]浙江大学医学院附属第一医院感染科,杭州312009 [2]绍兴市中心医院检验科

出　　处：《中华微生物学和免疫学杂志》2015年第3期183-187,共5页Chinese Journal of Microbiology and Immunology

摘　　要：目的：分析从绍兴市中心医院重症监护室（ ICU）内血流感染患者中分离的粘质沙雷菌株的同源性和耐药情况，为临床合理用药及感染控制提供依据。方法收集ICU病房2013年6月至2013年9月血流感染中分离培养出来的粘质沙雷菌株，并从ICU医务人员手上采集细菌，进行分离培养。对培养出的17株粘质沙雷菌进行药敏检测，用PCR技术扩增常见耐药基因，使用脉冲场凝胶电泳（ PFGE）技术进行同源性分析。收集患者的临床资料，用Spearman相关法进行统计学分析。结果17株粘质沙雷菌对第一代、二代头孢霉素、庆大霉素、环丙沙星耐药率100％，对阿米卡星及头孢他啶敏感，对碳青酶烯类的耐药率为11．76％～35．29％，PCR扩增结果显示1（5．88％）株粘质沙雷菌携带TEM基因，17株粘质沙雷菌PFGE分型一致。结论粘质沙雷菌是重要的致病菌，存在着院内传播现象，具有多重耐药性。临床应根据药敏试验合理选用抗菌药物，加强感染控制，防止耐药菌株在院内交叉传播和暴发流行。Objective To provide the guidance for the control and treatment of blood stream infec-tion caused by Serratia marcescens strains through analyzing the homology and drug resistant genes of the iso-lates collected from the Intensive Care Unit （ ICU） of Shaoxing County Central Hospital.Methods Serratia marcescens strains were isolated from ICU patients with blood stream infection and also from the hands of health care providers in the ICU from June 1st to September 30th, 2013.The antibiotic susceptibilities of the Serratia marcescens isolates were tested.PCR was performed to amplify the common drug resistant genes. Pulse-field gel electrophoresis （ PFGE） was carried out for analyzing the homology of all isolates.The com-plete clinical data of the patients were collected and statistically analyzed with Spearman′s rank correlation coefficient.Results Seventeen strains were isolated in this study.All of the 17 strains were resistant to the first and second generation Cephalosporin, Gentamicin and Ciprofloxacin, and sensitive to Amikacin and Ceftazidime.The drug resistant rates to Carbapenems ranged from 11.76%to 35.29%.One of the isolates （5.88%） carried the TEM gene.The results of PFGE showed that the phenotypes of all isolates were identi-cal.Conclusion Serratia marcescens strains were critical hospital infectious pathogens.They were able to spread in the hospital and were resistant to multiple antibiotics.Clinical physicians should properly use anti-biotics for the patients based on the result of drug susceptibility test.A control regulation for Serratia marces-cens infection within hospital should be enforced to avoid the cross infection and the outbreak of resistant strains.

关 键 词：重症监护室 粘质沙雷菌 同源性 耐药性 

分 类 号：R446.5[医药卫生—诊断学]