多重耐药鲍曼不动杆菌的聚类分析与病例调查

目的:了解多重耐药鲍曼不动杆菌(multidrug-resistant Acinetobacter baumannii,MDRAB)的同源性与流行病例,为控制医院感染及临床合理用药提供依据?方法:收集2012年6~12月临床分离的31株MDRAB,采用K-B纸片法检测12种抗菌药物敏感性,应用脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)分析菌株的同源性?回顾性分析MDRAB样本病例?结果:药敏结果显示,31株MDRAB对9种抗菌药物100%耐药率,包括4类抗菌药物?PFGE结果表明,31株菌分为5个克隆,20株属于B克隆,占64.52%,为主要流行菌株型,分布于8个病区,主要集中在重症监护病房?胸心外科?老年重症监护病房等重症病区?患者平均年龄64岁,侵入性操作占97%?结论:MDRAB对临床常用抗菌药物耐药比较严重?可能与院内存在克隆传播及患者年龄大?侵入性诊疗操作?合并多种基础疾病等多种因素有关?

Cluster analysis and case survey of multidrug-resistant Acinetobacter baumannii

Objective:To investigate the homology and prevalent cases of multidrug-resistant Acinetobacter baumannii (MDRAB) so as to provide reference for the prevention of nosocomial infection and clinical reasonable application of antibiotics. Methods:A total of 31 MDRAB isolates between June 2012 and December 2012 were collected,the susceptibility test of 12 antimicrobial agents was determined by K-B method,and the homology analysis of the strains was determined by pulsed-field gel electrophoresis(PFGE). Retrospective analysis of MDRAB sample cases was performed. Results:The antimicrobial susceptibility showed that the resistance rate of 31 MDRAB isolates to 9 antibiotics was 100%,including 4 kinds of antibacterial drugs. The results of PFGE demonstrated that 31 isolates were classified into 5 distinct genotypes,among those 20 isolates (accounting for 64.52%) of clone B were the predominant epidemic strains. The patients with MDRAB infection were distributed among 8 wards and mainly centralized in the intensive care unit,cardiothoracic surgery and geriatric intensive care unit. The average age of the patients was 64 years,and 97% of them had undergone invasive procedures. Conclusion:The MDRAB was seriously resistant to almost all clinically-used antibiotics. It may be closely related to a variety of factors,such as clonal spread,old age of patients,invasive treatment and patients with multiple underlying medical conditions.