CAJ | 학술논문

目的研究泛耐药鲍曼不动杆菌(PDRAB)医院获得性感染的临床因素、菌株耐药性与分子溯源，分析不同株系流行特征与感染相关因素。方法收集北京同仁医院2009年1月至2011年1月9次医院感染流行分离的PDRAB60株及临床资料；纸片琼脂扩散法检测其对12种抗生素的耐药表型；分别应用重复序列PCR( REP-PCR)和基质辅助激光解析电离飞行时间质谱仪(MAIDI-TOF-TOF MS)对流行菌株进行基因水平和蛋白水平的溯源和鉴定。结果除2株菌对亚胺培南、美罗培南敏感外，其余抗生素均耐药。60株PDRAB REP-PCR检测分为REP-A～L共12型，MALDI-TOF-TOF MS分为a～e5个类型。与MALDI-TOF-TOFMS相比，REP-PCR分型结果更为精细准确。呼吸机的携带与交叉传播可能是造成2009年7-10月呼吸科PDRAB大流行的主要原因；医护人员手传播是造成2010年1-2月外科重症监护病房PDRAB感染的关键因素；超级传播者鼻咽部或呼吸道PDRAB对周边环境的污染与传播是造成其余7次PDRAB流行的主要原因；急诊科是本院PDRAB获得性感染的传染源。结论早期识别和隔离超级传播者、加强环境器械消毒和医护人员手卫生、规范抗生素的使用是控制医院获得性感染的关键要素。MALDI-TOF-TOF MS方便、价廉、快速鉴定病原菌及分型优势有望成为微生物鉴定分型发展的方向。
목적 연구범내약포만불동간균(PDRAB)의원획득성감염적림상인소、균주내약성여분자소원，분석불동주계류행특정여감염상관인소。방법 수집북경동인의원2009년1월지2011년1월9차의원감염류행분리적PDRAB60주급림상자료；지편경지확산법검측기대12충항생소적내약표형；분별응용중복서렬PCR( REP-PCR)화기질보조격광해석전리비행시간질보의(MAIDI-TOF-TOF MS)대류행균주진행기인수평화단백수평적소원화감정。결과 제2주균대아알배남、미라배남민감외，기여항생소균내약。60주PDRAB REP-PCR검측분위REP-A～L공12형，MALDI-TOF-TOF MS분위a～e5개류형。여MALDI-TOF-TOFMS상비，REP-PCR분형결과경위정세준학。호흡궤적휴대여교차전파가능시조성2009년7-10월호흡과PDRAB대류행적주요원인；의호인원수전파시조성2010년1-2월외과중증감호병방PDRAB감염적관건인소；초급전파자비인부혹호흡도PDRAB대주변배경적오염여전파시조성기여7차PDRAB류행적주요원인；급진과시본원PDRAB획득성감염적전염원。결론 조기식별화격리초급전파자、가강배경기계소독화의호인원수위생、규범항생소적사용시공제의원획득성감염적관건요소。MALDI-TOF-TOF MS방편、개렴、쾌속감정병원균급분형우세유망성위미생물감정분형발전적방향。
ObjectiveTo explore the clinical factors, drug resistance and molecular epidemiology homologous characteristics of pan-drug resistant Acinetobacter baumannii ( PDRAB ) in acquired infections and analyze the correlation factor between epidemic characteristics and acquired infections.MethodsA total of 60 PDRAB strains from nine acquired infections and related clinic data were collected from January 2009 to January 2011.The drug-resistant phenotype was tested by disk diffusion methods.The isolate identification and homology were studied by automation repetitive-element sequence-based (REP)-PCR typing platform from genes and matrix-assisted laser desorption ionization-time of flight mass spectrometry ( MALDI-TOF-TOF MS) from proteins. ResultsAll strains were resistant to 12 antibiotics except 2 strains to imipenem and meropenem. The strains in this study were divided into 12 types (A-L) by REP-PCR. And 60 strains were also clustered to a-e types by MALDI-TOF-TOF MS. Compared with MALDI-TOF-TOF MS,REP-PCR tended to be more accurate.Breathing machine carriage and cross transmission were the main reasons for a major epidemic outbreak at department of pulnonary medicine from July 2009 to October 2009.Hand transmission of medical care personnel was a key factor for SICU 2010 January to February.The contamination and transmission to environment of PDRAB innasal pharynx or respiratory tract by superspreader were the main reasons for the other 7 epidemic outbreaks. Department of emergency medicine was the source of acquired infections. ConclusionThe key control measures of acquired infections are early identification and isolation of spreader, environment and instrument disinfection, hand washing and rational uses of antibiotics. MALDI-TOF-TOF MS will become a preferred tool of identification and classification of microorganisms because of its simple operation, affordable price and handling rapidity.