医院ICU多重耐药鲍曼不动杆菌的分布及同源性分析

目的对医院ICU多重耐药鲍曼不动杆菌(MDR-Ab)的分布及同源性进行分析,为临床MDR-Ab感染的控制与治疗提供参考。方法采用纸片扩散法(Kirby-Bauer,K-B)对本院2009年7月～2011年7月培养出的78株鲍曼不动杆菌(Ab)进行药敏试验,从中挑选出MDR-Ab,应用脉冲场凝胶电泳(PFDE)进行同源性分析,对同源性MDR-Ab感染者所在的床单元进行多部位取样培养及药敏试验,确定其感染来源、途径及分布特点。结果 1)共培养出的78株Ab,其中44株(56.4%)来自呼吸道标本;2)78株Ab对亚胺培南、头孢哌酮/舒巴坦及米诺环素的耐药率相对较低,共分离出8株MDR-Ab,A型4株,B型3株,C型1株;3)医护人员的手及清理床旁仪器的抹布MDR-Ab检出率为66.7%。结论本研究培养出的A、B型MDR-Ab有同源性且存在交叉感染现象;医务人员的无菌观念及无菌操作技术薄弱,手部卫生状况差是医院ICU MDR-Ab流行的重要因素。

Distribution and analysis of homology of multidrug-resistant Acinetobacter baumannii in an ICU

Objective To control and treat multidrug-resistant Acinetobacter baumannii(MDR-Ab) in an ICU by analyzing the distribution and homology of MDR-Ab.Methods MDR-Ab was isolated from 78 strains of cultured Ab.Strains collected from July 2009 to July 2011 and their susceptibility was analyzed using the Kirby-Bauer(K-B) method.Pulsed-field gel electrophoresis(PFDE) was then used to analyze homology.Samples from around the beds of patients infected with homologous MDR-Ab were cultured,and drug resistance was detected to determine the source of infection,route,and distribution characteristics of MDR-Ab.Results 1) In total,78 strains of Ab were cultured in this study,and 44 strains were distributed in respiratory tract(56.4%).2) Seventy-eight strains of cultured Ab had lower resistance to imipenem,cefoperazone/sulbactam,and minocycline.Eight strains of MDR-Ab were isolated;4 were type A,3 were type B,and 1 was type C.3) The hands of medical staff and equipment near clean beds tested positive for MDR-Ab at a rate of 66.7%.Conclusion The A and B types of MDR-Ab were homologous and cross-infection existed.Medical staff had a poor concept of sterility and sterilization and hand hygiene varied.These factors were key to the prevalence of MDR-Ab.