CAJ | 학술논문

目的：对住院患者不同部位分离纹带棒状杆菌的分子流行病学特征及耐药性进行分析，为临床进一步认识纹带棒状杆菌临床意义提供新的实验数据和思路。方法收集内蒙古医科大学附属医院2013年11月至2014年3月间45例住院患者不同部位分离纹带棒状杆菌45株，采用微量肉汤稀释法进行体外药敏试验；采用盐水棉拭子法对纹带棒状杆菌阳性患者周边环境进行采样、分离纹带棒状杆菌，并对分离的纹带棒状杆菌进行体外药敏试验；进一步采用脉冲场凝胶电泳（ PFGE）方法对45株纹带棒状杆菌进行分子分型。结果45株纹带棒状杆菌主要分离自神经外科病房（21株）、呼吸内科病房（8株）和重症监护病房（8株），其中39株分离自下呼吸道标本。2013年12月、2014年1月和2014年2月3个月内纹带棒状杆菌呈聚集分布。药敏试验结果显示，青霉素、红霉素、四环素、环丙沙星、克林霉素5种抗菌药物的最小抑菌浓度（ MIC90）值≥64μg/ml；庆大霉素、万古霉素和利福平的MIC90值均为0.5μg/ml；仅1株分离株对除克林霉素之外的所有抗菌药物全部敏感。 PFGE分型结果显示，41株纹带棒状杆菌共分为7个不同基因型，其中以0002型和0006型为优势型，分别占63％（26/41）和22％（9/41）。同一病房同期住院患者分离株高度同源。环境采样结果显示，纹带棒状杆菌分离阳性率达40％（8/20）。结论住院患者分离纹带棒状杆菌呈多重耐药特征，不同患者分离株高度同源。特定病房如神经外科、重症监护病房、呼吸内科等科室应重新评估其临床分离意义及与临床治疗之间的相关性。
목적：대주원환자불동부위분리문대봉상간균적분자류행병학특정급내약성진행분석，위림상진일보인식문대봉상간균림상의의제공신적실험수거화사로。방법수집내몽고의과대학부속의원2013년11월지2014년3월간45례주원환자불동부위분리문대봉상간균45주，채용미량육탕희석법진행체외약민시험；채용염수면식자법대문대봉상간균양성환자주변배경진행채양、분리문대봉상간균，병대분리적문대봉상간균진행체외약민시험；진일보채용맥충장응효전영（ PFGE）방법대45주문대봉상간균진행분자분형。결과45주문대봉상간균주요분리자신경외과병방（21주）、호흡내과병방（8주）화중증감호병방（8주），기중39주분리자하호흡도표본。2013년12월、2014년1월화2014년2월3개월내문대봉상간균정취집분포。약민시험결과현시，청매소、홍매소、사배소、배병사성、극림매소5충항균약물적최소억균농도（ MIC90）치≥64μg/ml；경대매소、만고매소화리복평적MIC90치균위0.5μg/ml；부1주분리주대제극림매소지외적소유항균약물전부민감。 PFGE분형결과현시，41주문대봉상간균공분위7개불동기인형，기중이0002형화0006형위우세형，분별점63％（26/41）화22％（9/41）。동일병방동기주원환자분리주고도동원。배경채양결과현시，문대봉상간균분리양성솔체40％（8/20）。결론주원환자분리문대봉상간균정다중내약특정，불동환자분리주고도동원。특정병방여신경외과、중증감호병방、호흡내과등과실응중신평고기림상분리의의급여림상치료지간적상관성。
Objective To explore the molecular epidemiological features and in vitro susceptibility profile of Corynebacterium striatum strains isolated from different sites of inpatients , and further provide new data and idea for clinicians to better get knowledge of the clinical significance of Corynebacterium striatum. Methods Fourty-five strains of Corynebacterium striatum isolated from different sites of inpatients from November, 2013 to March, 2014 in Affiliated hospital of Inner Mongolian medical university , and microdilution method was employed to do in vitro antibiotics susceptibility test.Saline-cotton swab method was used to sample the surrounding environmental surfaces for Corynebacterium striatum carrying patients , and suspected colonies were further identified and in vitro drug susceptibility test were performed.Pulsed Field Gel Electrophoresis ( PFGE) method was used to do molecular typing for 41 isolates of Corynebacterium striatum.Results Fourty-five isolates of Corynebacterium striatum strains were mainly isolated from neurosurgical unit(21 isolates),respiratory unit(8 isolates) and intensive care unit(8 isolates),39 isolates of which were isolated from lower respiratory tract.The 45 isolates presented an aggregate distribution in the following 3 months, which were December 2013, January 2014 and February 2014.In vitro antibiotics susceptibility test showed that MIC90 for penecillin, erythromycin, tetracycline, ciprofloxacin and clindamycin were 64 μg/ml or higher and the MIC 90 for gentamicin , vancomycin and rifampicin were all 0.5 μg/ml.Only one isolate was sensitive to all of the antibiotics tested , except clindamycin.PFGE typing results showed that 41 isolates were divided into 7 genotypes , among which 0002 type and 0006 type were the predominant types and accounted for 63%( 26/41 ) and 22%( 9/41 ) , respectively.The isolates from different patients showed high homology , which were isolated from the same unit during the same periods.For surrounding surfaces sampling , Corynebacterium striatum isolating rate was 40% (8/20).The isolates from environmental surfaces and those from the corresponding patients showed identical drug susceptibility profiles.Conclusions Corynebacterium striatum isolated from inpatients show multi-drug resistant profile , and different isolates from different patients are highly homologous.Specific units , such as neurosurgery unit, respiratory unit and intensive care unit , should reevaluate the clinical significance of Corynebacterium striatum and its relationship with clinical treatment measures supplemented .