RICU患者鲍曼不动杆菌感染临床特点及同源性

Clinical characteristics and homology of Acinetobacter baumannii infection in patients in a respiratory intensive care unit

目的研究某院呼吸科重症监护室(RICU)鲍曼不动杆菌克隆传播特点及感染患者的临床特点,以指导临床有效防控鲍曼不动杆菌的传播。方法对40株分离自RICU住院患者的鲍曼不动杆菌进行脉冲场凝胶电泳(PFGE)同源性及聚类分析,比较并确定菌株间的亲缘关系,同时对其耐药性及临床资料进行分析。结果 40株鲍曼不动杆菌分为A^K11种基因型,主要流行株为A、B、E型。耐药率最低的抗菌药物是亚胺培南(70.00%),其次是左氧氟沙星(77.50%)。40例感染者的平均年龄为67岁,平均住院时间41 d,12例感染者经治疗无效死亡。感染A型及E型菌株患者在各自住院时间上均存在交叉;而感染B型菌株的患者,后6例与前6例并无住院时间上的交叉。结论该组RICU鲍曼不动杆菌感染流行株为A、B、E基因型,耐药率高;感染者平均年龄较高,住院时间长。合理应用抗菌药物,严格执行无菌操作,加强对医疗环境和医疗器械的消毒灭菌,对减少鲍曼不动杆菌的传播至关重要。

Objective To study transmission characteristics of Acinetobacter baumannii （A.baumannii ）clone and clinical features of infected patients in a respiratory intensive care unit （RICU）,so as to guide the effective pre-vention and control of A.baumannii transmission.Methods 40 A.baumannii strains isolated from RICU patients were performed homology analysis by pulsed-field gel electrophoresis （PFGE）and cluster analysis,relationship of strains was determined,antimicrobial resistance and clinical data were analyzed.Results 40 A.baumannii strains were divided into 11 genotypes（A-K）,the main epidemic strains were type A,B and E.The resistant rate to imipen-em was the lowest（70.00%）,the next was levofloxacin （77.50%）.The average age of 40 infected patients was 67 years old,the average length of hospital stay was 41 days,12 patients died because of invalid treatment.There was overlapping hospitalization among patients infected with type A and E strains;among patients infected with type B strain,there was no overlapping hospitalization among the last 6 and first 6 infected patients.Conclusion The main epidemic strains of A.baumannii were type A,B and E,antimicrobial resistant rate is high;the infected patients are with high average age and long length of hospital stay.It is important to reduce the transmission of A.baumannii through rational use of antimicrobial agents,strict aseptic operation,and intensified disinfection and sterilization of hospital environment and medical devices.