CAJ | 학술논문

目的调查上海市重症监护病房(ICU)环境中耐碳青霉烯类鲍曼不动杆菌(CRAB)的流行型别,并分析ICU的环境分离株与临床分离株的同源性.方法对上海市21所医院ICU环境分离到的61株CRAB及其中一所医院(S医院)ICU临床分离到的14株CRAB,采用DiversiLab自动化重复序列(REP) -PCR分型系统,进行基因分型.结果 61株ICU环境分离的CRAB共分7型,其中G1型又分3个亚型,共46株细菌,占全部细菌的75.4％,分布于上海市的13所医院；G2、G3、G4、G5、G6和G7型分别为8株(13.1％)、2株(3.3％)、1株(1.6％)、1株(1.6％)、2株(3.3％)和1株(1.6％).在检出CRAB的13所医院中,除了D医院外,其他医院均分离到G1型CRAB.上海市S医院ICU共检出25株CRAB(14株临床株和11株环境株),分4型:其中G1型17株,为主要流行型别.由临床株和环境株的分布示意图显示:在外科ICU(SICU)中,环境株和临床株均以G1型为主,多个邻近床位病人检出G1型CRAB；心外科ICU(CICU)环境株以G1型为主,临床株以G2型为多,其中19床的病人及周围环境均检出G1型CRAB.结论上海市ICU环境中普遍存在G1型CRAB流行株,各医院ICU环境中存在流行株交叉污染的现象,ICU临床分离的CRAB与环境分离株有较高的相关性.应加强ICU环境消毒和手卫生,防止医院感染的暴发和流行.
목적 조사상해시중증감호병방(ICU)배경중내탄청매희류포만불동간균(CRAB)적류행형별,병분석ICU적배경분리주여림상분리주적동원성.방법 대상해시21소의원ICU배경분리도적61주CRAB급기중일소의원(S의원)ICU림상분리도적14주CRAB,채용DiversiLab자동화중복서렬(REP) -PCR분형계통,진행기인분형.결과 61주ICU배경분리적CRAB공분7형,기중G1형우분3개아형,공46주세균,점전부세균적75.4％,분포우상해시적13소의원；G2、G3、G4、G5、G6화G7형분별위8주(13.1％)、2주(3.3％)、1주(1.6％)、1주(1.6％)、2주(3.3％)화1주(1.6％).재검출CRAB적13소의원중,제료D의원외,기타의원균분리도G1형CRAB.상해시S의원ICU공검출25주CRAB(14주림상주화11주배경주),분4형:기중G1형17주,위주요류행형별.유림상주화배경주적분포시의도현시:재외과ICU(SICU)중,배경주화림상주균이G1형위주,다개린근상위병인검출G1형CRAB；심외과ICU(CICU)배경주이G1형위주,림상주이G2형위다,기중19상적병인급주위배경균검출G1형CRAB.결론 상해시ICU배경중보편존재G1형CRAB류행주,각의원ICU배경중존재류행주교차오염적현상,ICU림상분리적CRAB여배경분리주유교고적상관성.응가강ICU배경소독화수위생,방지의원감염적폭발화류행.
Objective To investigate the genotype of carbapenem-resistant Acinetobacter baumannii(CRAB) acquired from intensive care units (ICUs) environment in Shanghai hospitals and to evaluate the gene homology of CRAB isolated from patients and environment in ICUs in Shanghai hospital.Methods Sixty-one CRAB isolated from ICUs environment in Shanghai hospitals and 14 strains isolated from ICUs patients in S hospital were typed by REP-PCR based DiversiLab system.Results There were 7 types of the CRAB isolated from ICUs environment in Shanghai hospitals.Type G1 was the dominant type,accounting for 75.4％ of all CRAB,mainly in 13 hospitals in Shanghai.The percentage of the 7 types CRAB strains were 75.4％,13.1％,3.3％,1.6％,1.6％,3.3％ and 1.6％,respectively.Except for 1 strain of type G6 isolated in D hospital,type G1 CRAB was identified in every hospital which was isolated CRAB.There were 25 strains isolated from patients and environment in S hospital ICUs,which were divided into 4 types.Type G1 was the dominant type mainly distributed in SICU and CICU,including 9 from patients and 8 from environment.The distribution diagram of environmental and patients' strains indicated that the patients in adjacent bed isolated G1 CRAB in SICU and a patient in CICU and its surrounding environment both isolated G1 CRAB.Conclusion Type G1 is the dominant type in ICUs environment in Shanghai hospitals.There are inter-hospital transmission of CRAB in ICUs environment and highly homology of CRAB isolated from patients and environment in ICUs in Shanghai hospitals.Active surveillance of infection and colonization by CRAB,together with implementation of enhanced control strategies should be taken to eradicate CRAB in ICU environment.