呼吸机相关性肺炎患者血与痰标本中分离的鲍曼不动杆菌分子流行病学分析  

Molecular epidemiological analysis of the Acinetobacter baumannii isolates from blood and sputum specimens of patients with ventilator-associated pneumonia

作　　者：王露霞[1] 郑英俊 郭振辉[3] 李理[4] 王晓雅 李建勋[1] 卓超[5] 

机构地区：[1]广州军区广州总医院检验科,广州510010 [2]中国人民解放军69210部队医院 [3]广州军区广州总医院MICU-广东省老年感染与器官功能支持重点实验室 [4]广州军区广州总医院呼吸科,广州510010 [5]广州医科大学第一附属医院呼吸疾病研究所

出　　处：《中国感染与化疗杂志》2018年第1期58-63,共6页Chinese Journal of Infection and Chemotherapy

基　　金：广州市科研条件建设项目(穗科信字2012224-5).

摘　　要：目的对照分析ICU、内科ICU呼吸机相关性肺炎(VAP)患者的血标本和痰标本分离的鲍曼不动杆菌分子流行病学特点与患者临床特征。方法研究分两组:同一患者、同期从痰标本和血标本分离出鲍曼不动杆菌患者为A组;同一患者仅痰标本分离鲍曼不动杆菌、而血标本未分离出该菌患者为B组。收集患者临床信息,检测菌株体外药敏,并进行脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)。结果 2015年6-12月入选A组患者14例,获得非重复菌株28株;入选B组患者28例,获得非重复菌株28株。两组分离的56株鲍曼不动杆菌全部为多重耐药株,除对替加环素高度敏感外,对碳青霉烯类、第三代头孢菌素和氨基糖苷类的耐药率都在80%以上,两组分离株的药敏谱无统计学差异。A组同一患者两种标本获得的鲍曼不动杆菌非重复株经PFGE证实均为同源株,28株菌共有6个克隆型。B组28株菌按PFGE分为9个克隆型,其中有5个克隆与A组的克隆型相同。MLST分析,A组菌株共分为9个ST型(ST 195、ST 208、ST 229、ST 369、ST 373、ST 457、ST 836和2个新ST型ST N2、ST N5);B组菌株共分为8个ST型(ST 195、ST 208、ST 381以及5个新ST型ST N1、ST N2、ST N3、ST N4、ST N5)。两组主要ST型的比例差异无统计学意义。经e BURST分析,ST 195、ST 208、ST 457、ST 369、ST N1、ST N2、ST N51均属于CC92流行株。结论广州军区广州总医院ICU患者血与痰标本分离的鲍曼不动杆菌在药敏谱、基因分型上高度相似,病房存在CC92流行株的传播。VAP患者合并血流感染的危险因素与菌株基因型无直接关系。加强医院感染控制对防治鲍曼不动杆菌血流感染尤为重要。Objective To investigate the molecular epidemiological characteristics of the Acinetobacter baumannii strains isolated from blood and sputum samples of patients with ventilator-associated pneumonia（VAP） in ICU. Methods The patients were analyzed in two groups： Group A, A. baumannii was isolated from both blood and sputum, and Group B, A. baumannii was isolated only from sputum. Clinical data of the patients were collected, including the results of antimicrobial susceptibility test. Pulsed-field gel electrophoresis（PFGE） and multilocus sequence typing（MLST） were performed for the strains. Results During the study period from June 2015 to December 2105, 28 nonduplicate A. baumannii strains were collected from 14 patients in group A and 28 nonduplicate strains from 28 patients in group B. The 56 A. baumannii strains were multidrug-resistant（MDR）. More than 80% of the strains were resistant to carbapenem, third-generation cephalosporins or aminoglycoside, but highly sensitive to tigecycline. No significant difference was found for the resistance rates between group A and group B. The nonduplicate A. baumannii isolates from blood and sputum samples of the same patient in group A were all homologous strains confirmed by PFGE. Six pulsotypes were identified from the 28 strains in Group A and 9 pulsotypes in Group B. Five pulsotypes were shared between the two groups. MLST analysis showed that there were 9 ST types（ST195, ST208, ST229, ST369, ST373, ST457, ST836 and two new phenotypes ST N2, ST N5） in Group A and 8 ST types（ST195, ST208, ST381 and 5 new phenotypes ST N1, ST N2, ST N3, ST N4, ST N5） strains in group B. There was no significant difference in the proportion of the main ST types between the two groups. e BURST analysis indicated that ST195, ST208, ST457, ST369, ST N1, ST N2, ST N51 belonged to CC92 prevalent strain. Conclusions The antimicrobial susceptibility profile and genotype of A. baumannii isolates from blood and sputum samples are similar. There was CC92 prevalent strain in

关 键 词：鲍曼不动杆菌 多位点序列分型 血流感染 临床分析 

分 类 号：R378[医药卫生—病原生物学]