ICU多重耐药鲍曼不动杆菌分子流行病学调查

Multidrug-resistant Acinetobacter baumannii in an ICU: a molecular epidemiological study

目的:了解某医院重症监护病房(ICU)2013年5—6月及2014年3—4月多重耐药鲍曼不动杆菌(MDRAB)的分子流行病学状况。方法:通过前瞻性连续动态监测,收集2013年1月—2014年12月本医院ICU患者临床标本及对应床单位物表的多重耐药鲍曼不动杆菌,应用脉冲场凝胶电泳(PFGE)分析分子流行病学状况。结果:ICU内MDRAB的检出率达58.30%,83.24%来自痰及支气管吸取物。其耐药率呈逐步上升趋势,2014年7—12月达80%以上。脉冲场凝胶电泳结果表明,从临床和环境分离的32株MDRAB有2个PFGE型,分别命名为A和B。其中A型包括临床分离株编号1、2、6、7和11,环境分离株编号19、23、26、27和28;B型包括临床分离株编号13、14、15、16和17,环境分离株编号25、30和31。结论:MDRAB已为ICU内最重要的条件致病菌且主要引起呼吸道感染。监测期间医院有两次分别由克隆A和B引起的患者间MDRAB交叉传播。交叉感染通过污染的心电监护仪或床单位两种路径传播;加强手卫生,彻底的消毒隔离措施,能有效控制MDRAB在ICU流行。

Objective： To investigate the molecular epidemiology of multidrug-resistant Acinetobacter baumannii（ MDRAB） in the ICU of a hospital between May and June of 2013,and between March and April of 2014. Methods： By a prospective,serial approach of monitoring,we examined the MDRAB in clinical samples collected between January 2013 and December 2014 from ICU patients,bed sheets,and other environmental surfaces. Pulsed-field gel electrophoresis（ PFGE） was used to analyze the molecular epidemiology of MDRAB.Results： MDRAB detection rates in ICU was 58. 03%,the average isolated rate of MDRAB from sputum or bronchial lavage fluid was 83.24%,gradually incresae to 85.15% in second half of 2014. As shown by PFGE,32 clinical and environmental isolates of MDRAB comprised two PFGE types,nominated as types A and B. The type A accounted for clinical isolates numbered 1,2,6,7 and 11,and environmental isolates numbered 19,23,26,27 and 28; the type B accounted for clinical isolates numbered 13,14,15,16 and 17,and environment isolates numbered 25,30 and 31. Conclusion： MDRAB was the primary conditioned pathogen in ICU,causing respiratory tract infection principally. During the time of monitoring,there were two episodes of MDRAB cross-transmission contributable to clones A and B among patients in the hospital. The cross-infection may spread through contaminated ECG monitors and / or bed sheets. Reinforcement of hand hygiene and thorough measures for disinfection and isolation can be effective to prevent the MDRAB epidemic in ICU.