ICU多药耐药鲍氏不动杆菌医院感染的分子流行病学研究  

Molecular epidemiology of nosocomial infection due to multidrug-resistant Acinetobacter baumannii isolated from ICU patients

作　　者：许文[1] 范珊红[1] 金霞[1] 戈伟[1] 李颖[1] 慕彩妮[1] 闫永平[2] 

机构地区：[1]第四军医大学唐都医院疾病预防控制科,陕西西安710038 [2]第四军医大学军队流行病学教研室,陕西西安710032

出　　处：《中华医院感染学杂志》2015年第21期4822-4824,4837,共4页Chinese Journal of Nosocomiology

基　　金：陕西省社会发展攻关计划基金资助项目(2012K18-01-05)

摘　　要：目的调查某综合医院重症监护病房(ICU)多药耐药鲍氏不动杆菌(MDRAB)的临床和分子流行病学特征,为预防及控制MDRAB在医院内传播提供依据。方法收集2014年2-8月某综合医院综合ICU、神经外科ICU和胸腔外科ICU住院患者临床标本分离出的MDRAB 51例,并同期对患者及其周围环境、医护人员进行标本采集,采用脉冲场凝胶电泳(PFGE)法对所采集标本进行同源性分析。结果 2014年2-8月该院ICU发生的医院内MDRAB感染率为2.60%,51株MDRAB在痰液中最高占70.59%;感染部位主要以下呼吸道感染为主占70.59%;ICU临床与医疗环境分离的64株MDRAB,PFGE分为6型2个亚型,其中A型是主要流行株,与B型、C型在神经外科ICU与综合ICU引起流行。结论 MDRAB在该院部分ICU之间存在交叉感染,且医疗环境与临床菌株为同一克隆株,揭示接触传播可能是MDRAB的医院感染重要途径。OBJECTIVE To investigate the clinical and molecular epidemiological characteristics of multidrug-resistant Acinetobacter baumannii isolates from intensive care units（ICUs）of a general hospital so as to provide guidance for control and prevention of transmission of multidrug-resistant A.baumannii.METHODS A total of 51multidrug-resistant A.baumannii strains were isolated from the clinical specimens that were obtained from the patients who were hospitalized in the general ICU,neurosurgery department ICU,and thoracic surgery department ICU of ageneral hospital from Feb 2014 to Aug 2014.The specimens were collected from the patients and their surroundings as well as the health care workers during the same period,and the homology of the collected specimens was analyzed by using pulsed-field gel electrophoresis（PFGE）assay.RESULTS The incidence of multidrug-resistant A.baumannii infection was 2.60%in the ICUs of the hospital between Feb and Aug of 2014.Of the 51 multidrugresistant A.baumannii isolates,70.59% were isolated from the sputum specimens.Among the patients with multidrug-resistant A.baumannii infection,70.59% had the lower respiratory tract infection.The PEGE assay showed that the 64 multidrug-resistant A.baumannii strains isolated from the clinical and medical environment were divided into 6types and 2subtypes,type A was the predominant prevalent strain,an the type B and type C were prevalent in the neurosurgery department ICU and general ICU.CONCLUSION The cross infection caused by the multidrug-resistant A.baumannii isolates exists among the ICUs of the hospital.The strain from the medical environment and the clinical strain are the same clone strain,indicating that the contact transmission is the major route to have the multidrug-resistant A.baumannii infection.

关 键 词：重症监护病房 多药耐药鲍氏不动杆菌 医院感染 分子流行病学 脉冲场凝胶电泳仪 

分 类 号：R378[医药卫生—病原生物学]