泛耐药鲍氏不动杆菌医院感染暴发的溯源调查  

Tracing the source of an outbreak of pan-drug resistant Acinetobacter baumannii

作　　者：郭玉琴[1] 张静[1] 钟晓祝[1] 杨艳[1] 李春梅[1] 谭细兰[1] 

机构地区：[1]南方医科大学珠江医院感染科,广东广州510280

出　　处：《中华医院感染学杂志》2016年第20期4579-4582,共4页Chinese Journal of Nosocomiology

基　　金：广东省省级科技计划项目(2013B021800155)

摘　　要：目的调查神经外科重症监护病房(NSICU)泛耐药鲍氏不动杆菌医院感染,查找感染源和传播途径,为预防和控制医院感染提供参考依据。方法采集2015年1月初NSICU 4例感染患者标本(气道深部痰)及医务人员手和NSICU物体表面等环境标本,进行培养鉴定和药敏试验,采用16S-23SrRNA基因测序分析技术对分离出的泛耐药鲍氏不动杆菌进行同源性分析。结果 NSICU泛耐药鲍氏不动杆菌感染罹患率达36.36%(4/11),4株菌经16S-23SrRNA基因测序分析,同源性大于98%;NSICU环境监测在呼吸机面屏检出1株泛耐药鲍氏不动杆菌,其耐药谱与4位患者感染的病原菌相似,经16S-23SrRNA基因测序分析,同源性大于98%。结论该院NSICU发生的泛耐药鲍氏不动杆菌医院感染,经同源性分析确认为医院感染暴发,调查显示,患者A为感染源,病原菌可能通过污染的呼吸机面屏间接接触传播,导致本次感染暴发,经积极采取有效控制措施疫情得到及时控制。OBJECTIVE To investigate the source and route of transmission of the outbreak of nosocomial infections caused by pan-drug resistance Acinetobacter baumannli （PDRAB） in the neurosurgery care unit （NSICU）, so as to provide basis for the prevention and control of nosocomial infections. METHODS A total of 4 specimens from pa- tients＇ sputum （bronchial aspirates）, healthcare workers＂ hands and environment were collected in the early Jan. in 2015, and identification and drug susceptibility testing were performed. Gene sequencing analysis technology and phylogenic 16S-23SrRNA was performed to analyze the gene homology of PDRAB strains. RESULTS The preva- lence of PDRAB infection in NSICU was 36.36% （4/11）, The homology of 4 PDRAB strains was greater than 98% by 16S-23rRNA gene sequencing analysis. There was one strain of PDRAB detected from the screen of breathing machine by NSICU, whose drug-resistant spectrum was similar to the pathogenic bacteria from 4 infec- ted patients, and the homology of them was greater than 98% analyzed by 16S-23rRNA. CONCLUSION The out- break of nosocomial infections caused by PDRAB in NSICU is confirmed as a nosocomial infection by homology a- nalysis. We found the source of infection was patient A, and the pathogenic bacteria were through the infectious screen of breathing machine indirect contact transmission. The outbreak has been timely controlled by taking effec- tive control measures actively.

关 键 词：泛耐药鲍氏不动杆菌 医院感染暴发 同源性分析 

分 类 号：R378.99[医药卫生—病原生物学]