解甘露醇罗尔斯顿菌致4例透析患者血流感染的临床特征及同源性分析  

Clinical characteristics and homology analysis of 4 dialysis patients with bloodstream infections caused by Ralstonia mannitolilytica

作　　者：黄韵 张正银[1] 王亚婷[1] 薛玉芹 金英 郑怡菁 余彬 何怡玮 曲晓璐[2] 姚春瑛 张琴[3] 王闻卿 崔琦奇 HUANG Yun;ZHANG Zheng-yin;WANG Ya-ting;XUE Yu-qin;JIN Ying;ZHENG Yi-jing;YU Bin;HE Yi-wei;QU Xiao-lu;YAO Chun-ying;ZHANG Qin;WANG Wen-qing;CUI Qi-qi(Punan Hospital of Pudong New District, Shanghai 200126, China)

机构地区：[1]上海市浦东新区浦南医院检验科,上海200126 [2]上海市浦东新区浦南医院血液透析科,上海200126 [3]上海市浦东新区浦南医院医院感染管理科,上海200126 [4]浦东新区疾病预防控制中心,上海200126

出　　处：《中华医院感染学杂志》2018年第11期1658-1661,1678,共5页Chinese Journal of Nosocomiology

基　　金：上海市浦东新区卫生系统学科带头人培养实施计划基金资助项目(PWRd2015-08)

摘　　要：目的对解甘露醇罗尔斯顿菌所致血流感染的临床特征和医院内感染途径进行调査和分析,为临床预防和治疗提供依据。方法回顾性分析2017年10月5日-2018年1月14日医院4例解甘露醇罗尔斯顿菌所致血流感染患者的临床资料,共检出6株解甘露醇罗尔斯顿菌株,其中4株来源于血培养、2株来源于静脉留置导管尖端培养;对血液透析相关治疗用水及周围环境进行细菌培养、鉴定,并对分离到所有表型相似的同种细菌采用脉冲场凝胶电泳(FGE)进行同源性分析。结果所有患者均接受静脉导管置管并伴有≥3种基础疾病,发生血流感染时临床症状均为寒颤、发热;6株解甘露醇罗尔斯顿菌对头孢他啶、美罗培南、庆大霉素、妥布霉素、左氧氟沙星全部耐药,对头孢吡肟、亚胺培南、哌拉西林/他唑巴坦全部敏感;同源性分析结果显示6株菌为同一克隆株;血液透析相关治疗用水及环境采样均未分离到该菌。结论本研究4例解甘露醇罗尔斯顿菌所致的血流感染为同一菌株克隆传播,尽管该菌所致血流感染来源尚不明确,但在血液透析病房存在该菌的克隆传播。OBJECTIVE To investigate and analyze the clinical characteristics of bloodstream infections caused by Ralstonia mannitolilytica and routes of the nosocomial infections so as to provide guidance for clinical prevention and treatment.METHODS The clinical data of 4 patients with R.mannitolilytica-induced bloodstream infections who were treated in hospitals from Oct 5,2017 to Jan 14,2018 were retrospectively analyzed,totally 6 stains of R.mannitolilytica were isolated,4 of which were isolated from blood specimens,2 were isolated from tips of intravenous indwelling catheters.The hemodialysis-related treatment water and its surroundings were sampled for bacterial culture and identification,and the homology analysis was performed for the same species of isolated strains with similar phenotype by using pulsed-field gel electrophoresis（PFGE）.RESULTS All of the patients received the intravenous catheterization and were complicated with no less than 3 kinds of underlying diseases,the patients with the bloodstream infections presented with chills and fever.All of the 6 strains of R.mannitolilytica were resistant to ceftazidime,meropenem,gentamicin,tobramycin and levofloxacin and were susceptible to cefepime,imipenem and piperacillin-tazobactam.The result of the homology analysis showed that the 6 strains belonged to the same clonal strain.The R.mannitolilytica was not isolated from the hemodialysis-related treatment water or its surroundings.CONCLUSIONThe 6 strains of R.mannitolilyticaisolated from the 4 patients with R.mannitolilytica-induced bloodstream infections are the same clonal strain,although the origin of the bloodstream infection remains unknown,there is clonal transmission in hemodialysis wards.

关 键 词：血液透析 解甘露醇罗尔斯顿菌 血流感染 同源性分析 

分 类 号：R543[医药卫生—心血管疾病]