2004-2006年瑞金医院烧伤病房病原菌分布及分子流行病学分析

Analysis of the molecular epidemiology and distribution of pathogenic bacteria in burn wards of Rui- jiM Hospital from 2004 to 2006

目的了解瑞金医院烧伤病房院内感染病原菌的分布、耐药性和流行情况。方法2004年1月-2006年12月，从瑞金医院烧伤住院患者创面分泌物、静脉导管、血液、尿液、大便等标本中分离获得甲氧西林耐药金黄色葡萄球菌（MRSA）17株，铜绿假单胞菌52株，鲍氏不动杆菌11株。分析3年间该烧伤病房病原菌的分布和药物敏感试验情况；采用随机扩增多态DNA（RAPD）对院内感染病原菌进行同源性分析。结果金黄色葡萄球菌、铜绿假单胞菌和鲍氏不动杆菌是瑞金医院烧伤病房近年来的3种主要病原菌，金黄色葡萄球菌占首位，而3年间MRSA在金黄色葡萄球菌中的比例分别为77％（63／82）、85％（63／74）、75％（74／99）。3年中MRSA的主要耐药模式为阿米卡星／庆大霉素／红霉素／克林霉素／左氧氟沙星；铜绿假单胞菌的耐药模式为阿米卡星／庆大霉素／哌拉西林／头孢他啶／头孢哌酮／氨曲南／亚胺培南；鲍氏不动杆菌的耐药模式为阿米卡星／庆大霉素／哌拉西林／头孢他啶／亚胺培南／环丙沙星。3种细菌行RAPD同源性分析均为同一型别。结论笔者医院烧伤病房存在多种院内感染病原菌，细菌耐药情况严重，对这些细菌流行的控制应成为院内感染防治的重点。

Objective To analyse the distribution, drug resistance and epidemiology of pathogenic bacteria in the burn wards of Ruijin Hospital. Methods Seventeen strains of Methicillin resistant staphylococuss aureus （MRSA） , 52 strains of Pseudomonas aeruginosa（PA） , and 11 strains of Acinetobacter baumannii （AB） isolated from the wound secretion, venous catheters, blood, urine and stool etc. were collected from burn patients hospitalized in our department from January 2004 to December 2006. The distribution and the drug resistance profile of bacteria were analyzed, and the homology analysis was performed by ran- domly amplified polymorphic DNA （RAPD）. Results MRSA, PA and AB were the major strains in our burn wards in recent years, of which Staphylococuss aureus （SA） was the most dominant. During these 3 years, MRSA accounted for 77% （63/82） , 85% （63/74） , and 75% （74/99） , respectively, for SA isolated in this period. MRSA was resistant to Amikacin, Gentamicin, Erythromycin, Clindamycin and Levofloxacin; PA was resistant to Amikacin, Gentamicin, Piperacillin, Ceftazidime, Cefoperazone, Aztreonam and Imipenem ; AB was resistant to Amikacin, Gentamicin, Piperacillin, Ceftazidime, Imipenem and Ciprofloxacin. Three bacteria were found to belong to the same type in the RAPD homology analysis. Conclusions There are many kind of muhi-drug resistant pathogenic bacteria for nosocomial infection in our burn wards. To control the spread of infection due to above-mentioned 3 bacteria is the focus of nosocomial infection control.