内科重症监护病房铜绿假单胞菌医院感染同源性及临床特点

Homology and clinical characteristics of healthcare-associated infection with Pseudomonas aeruginosain medical intensive care unit

目的研究内科重症监护病房(MICU)铜绿假单胞菌(PA)医院感染的同源性及临床特点,以指导临床预防PA传播,提高治疗效果。方法对某院2014年1—12月MICU发生医院感染的25例患者分离的55株PA进行脉冲场凝胶电泳(PFGE)同源性分析及聚类分析,对其临床特点、耐药性及其传播特点进行分析。结果共调查25例患者,平均年龄为(69.62±2.13)岁,平均住院时间(49.34±3.18)d;在分离出PA之前,84.00%的患者应用广谱抗菌药物>2周,76.00%的患者入住过MICU,52.00%的患者使用呼吸机辅助通气。55株PA主要以A、F、H、K、N、V、W型为主要的流行菌株;感染A型、F型、H型及K型菌株的患者在各自住院时间上均存在交叉;有4例患者不同时期分离菌株的PFGE图谱分析显示不同菌型;PA对头孢他啶(72.73%)、哌拉西林/他唑巴坦(70.91%)、亚胺培南(70.91%)耐药率高,对阿米卡星耐药率最低(25.45%)。结论医疗机构应加强抗菌药物管理,加强医院感染控制措施,防止多重耐药和泛耐药细菌在医院内的播散。

ObjectiveTo study the homology and clinical characteristics of healthcareassociated infection（HAI） due to Pseudomonas aeruginosa （P. aeruginosa） in medical intensive care unit （MICU）, so as to guide the clinical prevention of P. aeruginosa transmission and improve therapeutic effect. Methods55 P. aeruginosa strains isolated from 25 patients with HAI in the MICU of a hospital in JanuaryDecember 2014 were performed pulsedfield gel electrophoresis （PFGE） homology analysis and clustering analysis, clinical characteristics, antimicrobial resistance, and transmission characteristics were analyzed.ResultsA total of 25 patients were investigated, with an average age of （69.62±2.13） years, mean hospital stay （49.34±3.18） days; prior to the isolation of P. aeruginosa, 84.00% of patients were treated with broadspectrum antimicrobial agents for 〉2 weeks, 76.00% of patients had been admitted to MICU, and 52.00% had a ventilatorassisted ventilation. 55 strains of P. aeruginosa were mainly A, F, H, K, N, V, and W, which were the main epidemic strains; patients infected with A, F, H and K strains all had cross in their hospital stay; PFGE profiles of isolates from 4 patients during different periods showed different strain patterns; resistance rates of P. aeruginosa to ceftazidime （72.73%）, piperacillin/tazobactam （70.91%）, and imipenem（70.91%） were all high, resistance rate to amikacin was the lowest（25.45%）. ConclusionManagement of antimicrobial agents should be strengthened in medical institutions, HAI control measures should be strengthened, so as to prevent the transmission of multidrugresistant and extensively drugresistant bacteria in hospitals.