新生儿重症监护病房黏质沙雷菌医院感染同源性分析及流行病学调查

Homology analysis and epidemiological investigation of serratia marcescens nosocomial infection in neonatal intensive care unit

目的了解某妇幼保健院新生儿重症监护病房(NICU)黏质沙雷菌耐药性和同源性,探寻NICU及相关科室黏质沙雷菌医院感染的流行路径。方法回顾性收集2021年3—6月分离自NICU及相关病区患儿和环境中的24株黏质沙雷菌,用VITEK2 compact进行药敏试验,用MALDI-TOF MS的聚类分析功能进行菌株同源性检测,并通过查阅病例和分析诊疗过程进行流行病学调查。结果引起NICU医院感染的黏质沙雷菌主要从新生儿的口周/口腔拭子中检出;对三代、四代头孢菌素、头孢哌酮/舒巴坦的耐药率为100%,但对喹诺酮类、碳青霉烯类、阿米卡星、替加环素敏感;同源性分析结果表明,这些菌株可分为A、B、C、D四群,本次NICU黏质沙雷菌院内感染的菌株为D。结论分离株的药敏结果基本一致,医护人员手和患儿口水巾是黏质沙雷菌在NICU暴发流行的主要途径,呼吸道传播可能是主要传播方式。

Objective To understand the drug resistance and homology of Serratia marcescens in neonatal intensive care unit(NICU)of a maternal and child health care hospital,and to explore the epidemic path of nosocomial infection of Serratia marcescens in NICU and related departments.Methods Retrospective collection of 24 strains of Serratia marcescens isolated from NICU patients and environment in 2021.VITEK2 compact was used for drug sensitivity test,MALDI-TOF MS cluster analysis function was used for strain homology detection,and epidemiological investigation was conducted by consulting cases and analyzing the diagnosis and treatment process.Results Serratia marcescens causing hospital infection in NICU was mainly detected from the perioral swabs of newborns.The resistance rate of these bacteria to third-and fourth-generation cephalosporins and cefoperazone/sulbactam was 100%,but was sensitive to quinolones,carbapenems,amikacin,and tigecycline.It was divided into four groups(A,B,C,and D)in homology analysis.The nosocomial infection of Serratia marcescens in NICU was mainly caused by type D.Conclusions Serratia marcescens isolates have simila drug resistance.Contact transmission may be the main transmission way by hands of medical staff and children's saliva wipes.