摘要
目的分析某综合医院重症监护病房(ICU)多药耐药鲍曼不动杆菌(MDR-AB)医院感染病例与医疗环境的相关性,了解ICU临床分离株与环境分离株MDR-AB的同源性。方法收集2014年2—8月某综合医院神经外科ICU、胸腔外科ICU和综合ICU住院患者分离出的多重耐药鲍曼不动杆菌临床标本,同时采集患者周围环境及医护人员标本,采用脉冲场凝胶电泳(PFGE)法对临床及环境标本进行同源性分析。结果 51株临床株分离自下呼吸道分泌物26株,随后依次为脑脊液、血液、腹腔引流液各3株,尿液、分泌物各2株,另2株分别是导管和胸水。临床与医疗环境分离的64株MDR-AB,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,并存在交叉感染。ICU环境中分离多药耐药鲍曼不动杆菌15株,主要分离自墨菲式滴管、血压计袖带、护理桌、床护栏等;A、B、C、D、E、F型分别为4株(26.7%)、2株(13.3%)、4株(26.7%)、3株(20.0%)、1株(6.7%)和1株(6.7%)。结论多药耐药鲍曼不动杆菌患者周围环境经常受到污染,MDR-AB在该院部分ICU之间存在交叉感染,MDR-AB感染临床分离株与环境株有较高的相关性。接触传播可能是MDR-AB的医院内感染重要途径。
Objective To analyze the correlation between multidrug resistance acinetobacter baumannii（ MDR-AB） nosocomial infections in intensive care unit（ ICU） and the contamination of the medical environment in a general hospital,and to learn about the homology of ICU isolated strains and strains isolated from the environment. Methods The specimens of inpatients from neurosurgical ICU,thoracic surgical ICU and general ICU as well as the environmental specimens around patients and specimens from paramedics from February to August 2014 were collected. The pulsed field gel electrophoresis（ PFGE） was applied to analyze the homology of these specimens. Results 51 strains were isolated from the clinical specimens,26 of them were from the secretion of lower respiration tracts,9 fromcerebrospinal fluid（ CSF）,blood and peritoneal drainage fluid（ 3 of each）,2 from urine and secretion,1 from tube and 1 from hydrothorax. 64 MDR-AB strains isolated form the ICU ambient environment were classified into 6 types and 2 subtypes by PFGE,of which type A was the main type. Type A together with type B and C caused the infections among neurosurgical ICU and general ICU,transmit infections were also observed. Fifteen MDR-AB strains were isolated from the ICU environment,mainly isolated from Murphy dropper,Sphygmomanometer cuff,Supply cart,Bed rails. 4（ 26. 7%）,2（ 13,3%）,4（ 26. 7%）,3（ 2. 0%）,1（ 6. 7%）,1（ 6. 7%） strains of type A,B,C,D,E,F were isolated,respectively. Conclusion The surroundings were often contaminated around the MDR-AB infected patients. Cross infections of MDR-AB were detected in some ICUs of the hospital. There is a close correlation between strains isolated from clinical specimens and those isolated from the environment. Contacting transmission might be the pivotal way of MDR-AB nosocomial infections.
出处
《中华全科医学》
2015年第12期1932-1934,1965,共4页
Chinese Journal of General Practice
基金
陕西省社会发展攻关计划项目(2012K18-01-05)
关键词
重症监护病房
多药耐药鲍曼不动杆菌
医院感染
医疗环境
PFGE
Intensive care unit
Multidrug-resistant Acinetobacter baumannii
Nosocomial infections
Medical environment
Pulsed-field gel electrophoresis
